TY - JOUR AU - Muthukumar, Radhakrishnan AU - Thepwongsa, Isaraporn AU - Sripa, Poompong AU - Jindawong, Bangonsri AU - Jenwitheesuk, Kamonwan AU - Virasiri, Surapol PY - 2025/3/27 TI - Preclinical Medical Students' Perspectives and Experiences With Structured Web-Based English for Medical Purposes Courses: Cross-Sectional Study JO - JMIR Med Educ SP - e65779 VL - 11 KW - English for medical purposes KW - online course KW - online learning KW - online education KW - medical students KW - medical school KW - online KW - online learners KW - perspectives KW - English KW - English language KW - medical research KW - educational method KW - lesson KW - course KW - instructional designs KW - English for medical professional KW - EMP KW - barriers KW - web-based N2 - Background: English for medical purposes (EMP) is essential for medical students as it serves as a foundational language for medical communication and education. However, students often undervalue its importance within the medical curriculum. Given their demanding schedules and workload, educational methods for EMP must align with their needs. Structured web-based learning offers flexibility and convenience, yet limited research has explored its exclusive application for EMP in undergraduate medical education. Objective: This study aimed to evaluate medical students? perspectives on structured web-based EMP courses and assess their impact on medical English proficiency using objective and subjective measures. Methods: Structured web-based EMP courses were developed based on evidence-based guidelines, addressing barriers to web-based learning during development and implementation. A cross-sectional study was conducted with 535 medical students who completed these courses. Data were collected via questionnaires, the learning management system, and the Khon Kaen University Medical English Test (KKUMET), which assessed proficiency in listening, reading, writing, and speaking. Data were analyzed using descriptive statistics. Results: Of the 535 students, 452 (84.5%) completed the survey. Participants reported confidence in reading (mean 4.11, SD 0.87), vocabulary (mean 4.04, SD 0.84), and listening skills (mean 4, SD 0.89), but lower confidence in writing skills (mean 3.46, SD 1.07). The KKUMET results showed statistically significant improvements in all 4 language skills after course completion (P<.001). The top-rated benefits of the courses were convenience (mean 4.77, SD 0.59), sufficient instruction (mean 4.5, SD 0.85), and clear content (mean 4.41, SD 0.80). Conclusions: Structured web-based EMP courses are relevant and well received by medical students. These courses significantly improve students? medical English proficiency, as evidenced by both subjective feedback and objective measures. Medical educators should consider integrating structured web-based EMP programs to better support students? language proficiency in medical contexts. UR - https://mededu.jmir.org/2025/1/e65779 UR - http://dx.doi.org/10.2196/65779 ID - info:doi/10.2196/65779 ER - TY - JOUR AU - Jacobs, Chris PY - 2025/3/18 TI - Examining Multimodal AI Resources in Medical Education: The Role of Immersion, Motivation, and Fidelity in AI Narrative Learning JO - JMIR Med Educ SP - e72190 VL - 11 KW - artificial intelligence KW - cinematic clinical narrative KW - cinemeducation KW - medical education KW - narrative learning KW - AI KW - medical students KW - preclinical education KW - long-term retention KW - pharmacology KW - AI tools KW - GPT-4 KW - image KW - applicability KW - CCN UR - https://mededu.jmir.org/2025/1/e72190 UR - http://dx.doi.org/10.2196/72190 ID - info:doi/10.2196/72190 ER - TY - JOUR AU - Bland, Tyler PY - 2025/3/18 TI - Author?s Reply: Examining Multimodal AI Resources in Medical Education: The Role of Immersion, Motivation, and Fidelity in AI Narrative Learning JO - JMIR Med Educ SP - e72336 VL - 11 KW - artificial intelligence KW - cinematic clinical narrative KW - cinemeducation KW - medical education KW - narrative learning KW - pharmacology KW - AI KW - medical students KW - preclinical education KW - long-term retention KW - AI tools KW - GPT-4 KW - image KW - applicability KW - CCN UR - https://mededu.jmir.org/2025/1/e72336 UR - http://dx.doi.org/10.2196/72336 ID - info:doi/10.2196/72336 ER - TY - JOUR AU - Ali-Saleh, Ola AU - Massalha, Layalleh AU - Halperin, Ofra PY - 2025/3/12 TI - Evaluation of a Simulation Program for Providing Telenursing Training to Nursing Students: Cohort Study JO - JMIR Med Educ SP - e67804 VL - 11 KW - simulation-based training program KW - telenursing KW - simulation KW - program KW - training KW - nursing student KW - nursing care KW - Israel KW - nurse-patient relationship KW - telehealth nursing KW - remote nursing care KW - undergraduate KW - cohort study KW - knowlege; self efficacy; skills; attitudes N2 - Background: Telenursing has become prevalent in providing care to diverse populations experiencing different health conditions both in Israel and globally. The nurse-patient relationship aims to improve the condition of individuals requiring health services. Objectives: This study aims to evaluate nursing graduates? skills and knowledge regarding remote nursing care prior to and following a simulation-based telenursing training program in an undergraduate nursing degree. Methods: A cohort study assessed 114 third-year nursing students using comprehensive evaluation measures of knowledge, skills, attitudes, self-efficacy, and clinical skills regarding remote nursing care. Assessments were conducted at 2 critical time points: prior to and following a structured simulation-based training intervention. Results: Participant demographics revealed a predominantly female sample (101/114, 88.6%), aged 20?50 years (mean 25.68, SD 4.59 years), with moderate to advanced computer and internet proficiency. Notably, 91.2% (104/114) had no telenursing exposure, yet 75.4% (86/114) expressed training interest. Statistical analyses demonstrated significant improvements across all measured variables, characterized by moderate to high effect sizes. Key findings included substantial increases in telenursing awareness, knowledge, skills, attitudes and self-efficacy; significant reduction in perceived barriers to remote care delivery; and complex interrelation dynamics between variables. A multivariate analysis revealed nuanced correlations: higher awareness and knowledge were consistently associated with more positive attitudes and increased self-efficacy. Positive attitudes correlated with enhanced self-efficacy and reduced perceived barriers. Change score analyses further indicated that increased awareness and knowledge facilitated more positive attitudinal shifts, while heightened awareness and positive attitudes corresponded with decreased implementation barriers. Conclusions: The study underscores the critical importance of integrating targeted telenursing training into nursing education. By providing comprehensive preparation, educational programs can equip students to deliver optimal remote care services. The COVID-19 pandemic has definitively demonstrated that remote nursing will be central to future health care delivery, emphasizing the urgent need to prepare nursing students for this emerging health care paradigm. UR - https://mededu.jmir.org/2025/1/e67804 UR - http://dx.doi.org/10.2196/67804 ID - info:doi/10.2196/67804 ER - TY - JOUR AU - Gerdes, John AU - Schooley, Benjamin AU - Sharp, Dakota AU - Miller, Juliana PY - 2025/2/20 TI - The Design and Evaluation of a Simulation Tool for Audiology Screening Education: Design Science Approach JO - JMIR Form Res SP - e47150 VL - 9 KW - design science KW - audiology KW - simulation KW - hearing screening KW - framework KW - speech pathology KW - training N2 - Background: The early identification of hearing loss and ear disorders is important. Regular screening is recommended for all age groups to determine whether a full hearing assessment is necessary and allow for timely treatment of hearing problems. Procedural training is needed for new speech-language pathology students as well as continuing education for those trained to perform this screening procedure. Limited availability and access to physical training locations can make it difficult to receive the needed training. Objective: The aims of this study were to (1) develop a new hearing screening simulation software platform and (2) assess its effectiveness in training a group of graduate-level speech-language pathology students in hearing screening procedures. Methods: An audiology simulator modeled after the commercial Grason-Stadler GSI39 combination audiometer and tympanometer device was developed to serve as a precursor to traditional face-to-face clinical instruction. A description of the simulator development process, guided by a design science approach, is presented. The initiation phase established the initial criteria for the simulator design. This was followed by an iterative process involving prototype development, review, and critique by the clinical faculty. This feedback served as input for the subsequent iteration. The evaluation of the final prototype involved 33 speech-language pathology graduate students as part of an introductory audiology class. These students were randomly assigned to control (receiving in-person instruction) and test (in-person instruction and simulation tool use) groups. Students in both groups were subsequently evaluated as they performed audiology screenings on human participants and completed a 25-item pretest and posttest survey. Nonparametric Mann-Whitney U tests were conducted on the mean differences between pretest and posttest ordinal survey response data to compare the control and intervention groups. Results: The results indicated that the students who used the simulation tool demonstrated greater confidence in their ability to (1) explain hearing screening procedures to a child (P=.02), (2) determine whether otoscopy results are normal (P=.02), and (3) determine whether otoscopy results are abnormal (P=.03). Open-ended responses indicated that the students found that the hands-on experience provided by the simulator resulted in an easy-to-use and useful learning experience with the audiometer, which increased their confidence in their ability to perform hearing screenings. Conclusions: Software-based education simulation tools for audiology screening may provide a beneficial approach to educating students and professionals in hearing screening training. The tool tested in this study supports individualized, self-paced learning with context-sensitive feedback and performance assessment, incorporating an extensible approach to supporting simulated subjects. UR - https://formative.jmir.org/2025/1/e47150 UR - http://dx.doi.org/10.2196/47150 UR - http://www.ncbi.nlm.nih.gov/pubmed/39977027 ID - info:doi/10.2196/47150 ER - TY - JOUR AU - Escamilla-Sanchez, Alejandro AU - López-Villodres, Antonio Juan AU - Alba-Tercedor, Carmen AU - Ortega-Jiménez, Victoria María AU - Rius-Díaz, Francisca AU - Sanchez-Varo, Raquel AU - Bermúdez, Diego PY - 2025/2/19 TI - Instagram as a Tool to Improve Human Histology Learning in Medical Education: Descriptive Study JO - JMIR Med Educ SP - e55861 VL - 11 KW - medical education KW - medical students KW - histology KW - pathology KW - e-learning KW - computer-based KW - social media KW - Instagram KW - Meta KW - community-oriented KW - usability KW - utility KW - accessibility N2 - Background: Student development is currently taking place in an environment governed by new technologies and social media. Some platforms, such as Instagram or X (previously known as ?Twitter?), have been incorporated as additional tools for teaching and learning processes in higher education, especially in the framework of image-based applied disciplines, including radiology and pathology. Nevertheless, the role of social media in the teaching of core subjects such as histology has hardly been studied, and there are very few reports on this issue. Objective: The aim of this work was to investigate the impact of implementing social media on the ability to learn human histology. For this purpose, a set of voluntary e-learning activities was shared on Instagram as a complement to traditional face-to-face teaching. Methods: The proposal included questionnaires based on multiple-choice questions, descriptions of histological images, and schematic diagrams about the subject content. These activities were posted on an Instagram account only accessible by second-year medical students from the University of Malaga. In addition, students could share their own images taken during the laboratory practice and interact with their peers. Results: Of the students enrolled in Human Histology 2, 85.6% (143/167) agreed to participate in the platform. Most of the students valued the initiative positively and considered it an adequate instrument to improve their final marks. Specifically, 68.5% (98/143) of the student body regarded the multiple-choice questions and image-based questions as the most useful activities. Interestingly, there were statistically significant differences between the marks on the final exam (without considering other evaluation activities) for students who participated in the activity compared with those who did not or barely participated in the activity (P<.001). There were no significant differences by degree of participation between the more active groups. Conclusions: These results provide evidence that incorporating social media may be considered a useful, easy, and accessible tool to improve the learning of human histology in the context of medical degrees. UR - https://mededu.jmir.org/2025/1/e55861 UR - http://dx.doi.org/10.2196/55861 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55861 ER - TY - JOUR AU - Teng, Peng AU - Xu, Youran AU - Qian, Kaoliang AU - Lu, Ming AU - Hu, Jun PY - 2025/1/17 TI - Case-Based Virtual Reality Simulation for Severe Pelvic Trauma Clinical Skill Training in Medical Students: Design and Pilot Study JO - JMIR Med Educ SP - e59850 VL - 11 KW - case-based learning KW - virtual reality KW - pelvic fracture KW - severe pelvic trauma KW - hemodynamic instability KW - clinical skill training KW - VR KW - pelvic trauma KW - medical student KW - pilot study KW - orthopedic surgery KW - theoretical teaching KW - acceptability N2 - Background: Teaching severe pelvic trauma poses a significant challenge in orthopedic surgery education due to the necessity of both clinical reasoning and procedural operational skills for mastery. Traditional methods of instruction, including theoretical teaching and mannequin practice, face limitations due to the complexity, the unpredictability of treatment scenarios, the scarcity of typical cases, and the abstract nature of traditional teaching, all of which impede students? knowledge acquisition. Objective: This study aims to introduce a novel experimental teaching methodology for severe pelvic trauma, integrating virtual reality (VR) technology as a potent adjunct to existing teaching practices. It evaluates the acceptability, perceived ease of use, and perceived usefulness among users and investigates its impact on knowledge, skills, and confidence in managing severe pelvic trauma before and after engaging with the software. Methods: A self-designed questionnaire was distributed to 40 students, and qualitative interviews were conducted with 10 teachers to assess the applicability and acceptability. A 1-group pretest-posttest design was used to evaluate learning outcomes across various domains, including diagnosis and treatment, preliminary diagnosis, disease treatment sequencing, emergency management of hemorrhagic shock, and external fixation of pelvic fractures. Results: A total of 40 students underwent training, with 95% (n=38) affirming that the software effectively simulated real-patient scenarios. All participants (n=40, 100%) reported that completing the simulation necessitated making the same decisions as doctors in real life and found the VR simulation interesting and useful. Teacher interviews revealed that 90% (9/10) recognized the VR simulation?s ability to replicate complex clinical cases, resulting in enhanced training effectiveness. Notably, there was a significant improvement in the overall scores for managing hemorrhagic shock (t39=37.6; 95% CI 43.6-48.6; P<.001) and performing external fixation of pelvic fractures (t39=24.1; 95% CI 53.4-63.3; P<.001) from pre- to postsimulation. Conclusions: The introduced case-based VR simulation of skill-training methodology positively influences medical students? clinical reasoning, operative skills, and self-confidence. It offers an efficient strategy for conserving resources while providing quality education for both educators and learners. UR - https://mededu.jmir.org/2025/1/e59850 UR - http://dx.doi.org/10.2196/59850 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59850 ER - TY - JOUR AU - Zhang, Yong AU - Lu, Xiao AU - Luo, Yan AU - Zhu, Ying AU - Ling, Wenwu PY - 2025/1/9 TI - Performance of Artificial Intelligence Chatbots on Ultrasound Examinations: Cross-Sectional Comparative Analysis JO - JMIR Med Inform SP - e63924 VL - 13 KW - chatbots KW - ChatGPT KW - ERNIE Bot KW - performance KW - accuracy rates KW - ultrasound KW - language KW - examination N2 - Background: Artificial intelligence chatbots are being increasingly used for medical inquiries, particularly in the field of ultrasound medicine. However, their performance varies and is influenced by factors such as language, question type, and topic. Objective: This study aimed to evaluate the performance of ChatGPT and ERNIE Bot in answering ultrasound-related medical examination questions, providing insights for users and developers. Methods: We curated 554 questions from ultrasound medicine examinations, covering various question types and topics. The questions were posed in both English and Chinese. Objective questions were scored based on accuracy rates, whereas subjective questions were rated by 5 experienced doctors using a Likert scale. The data were analyzed in Excel. Results: Of the 554 questions included in this study, single-choice questions comprised the largest share (354/554, 64%), followed by short answers (69/554, 12%) and noun explanations (63/554, 11%). The accuracy rates for objective questions ranged from 8.33% to 80%, with true or false questions scoring highest. Subjective questions received acceptability rates ranging from 47.62% to 75.36%. ERNIE Bot was superior to ChatGPT in many aspects (P<.05). Both models showed a performance decline in English, but ERNIE Bot?s decline was less significant. The models performed better in terms of basic knowledge, ultrasound methods, and diseases than in terms of ultrasound signs and diagnosis. Conclusions: Chatbots can provide valuable ultrasound-related answers, but performance differs by model and is influenced by language, question type, and topic. In general, ERNIE Bot outperforms ChatGPT. Users and developers should understand model performance characteristics and select appropriate models for different questions and languages to optimize chatbot use. UR - https://medinform.jmir.org/2025/1/e63924 UR - http://dx.doi.org/10.2196/63924 ID - info:doi/10.2196/63924 ER - TY - JOUR AU - Bland, Tyler PY - 2025/1/6 TI - Enhancing Medical Student Engagement Through Cinematic Clinical Narratives: Multimodal Generative AI?Based Mixed Methods Study JO - JMIR Med Educ SP - e63865 VL - 11 KW - artificial intelligence KW - cinematic clinical narratives KW - cinemeducation KW - medical education KW - narrative learning KW - AI KW - medical student KW - pharmacology KW - preclinical education KW - long-term retention KW - AI tools KW - GPT-4 KW - image KW - applicability N2 - Background: Medical students often struggle to engage with and retain complex pharmacology topics during their preclinical education. Traditional teaching methods can lead to passive learning and poor long-term retention of critical concepts. Objective: This study aims to enhance the teaching of clinical pharmacology in medical school by using a multimodal generative artificial intelligence (genAI) approach to create compelling, cinematic clinical narratives (CCNs). Methods: We transformed a standard clinical case into an engaging, interactive multimedia experience called ?Shattered Slippers.? This CCN used various genAI tools for content creation: GPT-4 for developing the storyline, Leonardo.ai and Stable Diffusion for generating images, Eleven Labs for creating audio narrations, and Suno for composing a theme song. The CCN integrated narrative styles and pop culture references to enhance student engagement. It was applied in teaching first-year medical students about immune system pharmacology. Student responses were assessed through the Situational Interest Survey for Multimedia and examination performance. The target audience comprised first-year medical students (n=40), with 18 responding to the Situational Interest Survey for Multimedia survey (n=18). Results: The study revealed a marked preference for the genAI-enhanced CCNs over traditional teaching methods. Key findings include the majority of surveyed students preferring the CCN over traditional clinical cases (14/18), as well as high average scores for triggered situational interest (mean 4.58, SD 0.53), maintained interest (mean 4.40, SD 0.53), maintained-feeling interest (mean 4.38, SD 0.51), and maintained-value interest (mean 4.42, SD 0.54). Students achieved an average score of 88% on examination questions related to the CCN material, indicating successful learning and retention. Qualitative feedback highlighted increased engagement, improved recall, and appreciation for the narrative style and pop culture references. Conclusions: This study demonstrates the potential of using a multimodal genAI-driven approach to create CCNs in medical education. The ?Shattered Slippers? case effectively enhanced student engagement and promoted knowledge retention in complex pharmacological topics. This innovative method suggests a novel direction for curriculum development that could improve learning outcomes and student satisfaction in medical education. Future research should explore the long-term retention of knowledge and the applicability of learned material in clinical settings, as well as the potential for broader implementation of this approach across various medical education contexts. UR - https://mededu.jmir.org/2025/1/e63865 UR - http://dx.doi.org/10.2196/63865 ID - info:doi/10.2196/63865 ER - TY - JOUR AU - Roos, Jonas AU - Martin, Ron AU - Kaczmarczyk, Robert PY - 2024/12/17 TI - Evaluating Bard Gemini Pro and GPT-4 Vision Against Student Performance in Medical Visual Question Answering: Comparative Case Study JO - JMIR Form Res SP - e57592 VL - 8 KW - medical education KW - visual question answering KW - image analysis KW - large language model KW - LLM KW - student KW - performance KW - comparative KW - case study KW - artificial intelligence KW - AI KW - ChatGPT KW - effectiveness KW - diagnostic KW - training KW - accuracy KW - utility KW - image-based KW - question KW - image KW - AMBOSS KW - English KW - German KW - question and answer KW - Python KW - AI in health care KW - health care N2 - Background: The rapid development of large language models (LLMs) such as OpenAI?s ChatGPT has significantly impacted medical research and education. These models have shown potential in fields ranging from radiological imaging interpretation to medical licensing examination assistance. Recently, LLMs have been enhanced with image recognition capabilities. Objective: This study aims to critically examine the effectiveness of these LLMs in medical diagnostics and training by assessing their accuracy and utility in answering image-based questions from medical licensing examinations. Methods: This study analyzed 1070 image-based multiple-choice questions from the AMBOSS learning platform, divided into 605 in English and 465 in German. Customized prompts in both languages directed the models to interpret medical images and provide the most likely diagnosis. Student performance data were obtained from AMBOSS, including metrics such as the ?student passed mean? and ?majority vote.? Statistical analysis was conducted using Python (Python Software Foundation), with key libraries for data manipulation and visualization. Results: GPT-4 1106 Vision Preview (OpenAI) outperformed Bard Gemini Pro (Google), correctly answering 56.9% (609/1070) of questions compared to Bard?s 44.6% (477/1070), a statistically significant difference (?2?=32.1, P<.001). However, GPT-4 1106 left 16.1% (172/1070) of questions unanswered, significantly higher than Bard?s 4.1% (44/1070; ?2?=83.1, P<.001). When considering only answered questions, GPT-4 1106?s accuracy increased to 67.8% (609/898), surpassing both Bard (477/1026, 46.5%; ?2?=87.7, P<.001) and the student passed mean of 63% (674/1070, SE 1.48%; ?2?=4.8, P=.03). Language-specific analysis revealed both models performed better in German than English, with GPT-4 1106 showing greater accuracy in German (282/465, 60.65% vs 327/605, 54.1%; ?2?=4.4, P=.04) and Bard Gemini Pro exhibiting a similar trend (255/465, 54.8% vs 222/605, 36.7%; ?2?=34.3, P<.001). The student majority vote achieved an overall accuracy of 94.5% (1011/1070), significantly outperforming both artificial intelligence models (GPT-4 1106: ?2?=408.5, P<.001; Bard Gemini Pro: ?2?=626.6, P<.001). Conclusions: Our study shows that GPT-4 1106 Vision Preview and Bard Gemini Pro have potential in medical visual question-answering tasks and to serve as a support for students. However, their performance varies depending on the language used, with a preference for German. They also have limitations in responding to non-English content. The accuracy rates, particularly when compared to student responses, highlight the potential of these models in medical education, yet the need for further optimization and understanding of their limitations in diverse linguistic contexts remains critical. UR - https://formative.jmir.org/2024/1/e57592 UR - http://dx.doi.org/10.2196/57592 ID - info:doi/10.2196/57592 ER - TY - JOUR AU - Wooldridge, S. Jennalee AU - Soriano, C. Emily AU - Chu, Gage AU - Shirazi, Anaheed AU - Shapiro, Desiree AU - Patterson, Marta AU - Kim, Hyun-Chung AU - Herbert, S. Matthew PY - 2024/11/26 TI - Optimizing Compassion Training in Medical Trainees Using an Adjunct mHealth App: A Preliminary Single-Arm Feasibility and Acceptability Study JO - JMIR Form Res SP - e60670 VL - 8 KW - mobile phone KW - compassion KW - empathy KW - mHealth KW - mobile health KW - medical student KW - medical resident KW - mHealth app KW - app KW - medical trainee KW - training KW - feasibility KW - acceptability KW - pilot KW - mindfulness KW - self-compassion KW - smartphone app KW - applicability N2 - Background: While structured compassion training programs have shown promise for increasing compassion among medical trainees, a major challenge is applying the concepts and practices taught during the program into the complex, dynamic, time-pressured, and often hectic hospital workplace. Objective: The purpose of this pilot study was to examine the feasibility, acceptability, and preliminary effects of Compassion Coach, a mobile health (mHealth) smartphone app designed to bolster a 6-week mindfulness and self-compassion training program for medical trainees. Methods: In Compassion Coach, notifications to remind, encourage, and measure the perceived impact of informal mindfulness and compassion practices taught during the program were delivered at 7 AM, 12 PM, and 7 PM, respectively, 3 times per week over the course of the training program. The app also contained a library of guided audio formal mindfulness and compassion practices to allow quick and easy access. In this pilot study, we collected data from 29 medical students and residents who downloaded Compassion Coach and completed surveys assessing perceived effectiveness and acceptability. Engagement with the Compassion Coach app was passively tracked through notification response rate and library resource access over time. Results: The average response rate to notifications was 58% (SD 29%; range 12%-98%), with a significant decline over time (P=.009; odds ratio 0.98, 95% CI 0.96-0.99). Across all participants and occasions, the majority agreed the informal practices prompted by Compassion Coach helped them feel grounded and centered (110/150, 73%), improved compassion (29/41, 71%), reduced burnout (106/191, 56%), and improved their mood (133/191, 70%). In total, 16 (55%) of the 29 participants accessed guided audio recordings on average 3 (SD 3.4) times throughout the program. At the posttreatment time point, most participants (13/18, 72%) indicated that Compassion Coach helped them engage in compassion practices in daily life, and half (9/18, 50%) indicated that Compassion Coach helped improve interactions with patients. Conclusions: Overall, preliminary results of Compassion Coach are encouraging and suggest the integration of a smartphone app with an ongoing mindfulness and self-compassion training program may bolster the effects of the program on medical trainees. However, there was variability in engagement with Compassion Coach and perceived helpfulness. Additional research is indicated to optimize this novel mHealth approach and conduct a study powered to formally evaluate effects. UR - https://formative.jmir.org/2024/1/e60670 UR - http://dx.doi.org/10.2196/60670 UR - http://www.ncbi.nlm.nih.gov/pubmed/39589766 ID - info:doi/10.2196/60670 ER - TY - JOUR AU - Mørk, Gry AU - Bonsaksen, Tore AU - Larsen, Sønnik Ole AU - Kunnikoff, Martin Hans AU - Lie, Stangeland Silje PY - 2024/11/19 TI - Virtual Reality Simulation in Undergraduate Health Care Education Programs: Usability Study JO - JMIR Med Educ SP - e56844 VL - 10 KW - 360° videos KW - health professions education KW - virtual reality KW - usability study KW - undergraduates KW - university KW - students KW - simulation N2 - Background: Virtual reality (VR) is increasingly being used in higher education for clinical skills training and role-playing among health care students. Using 360° videos in VR headsets, followed by peer debrief and group discussions, may strengthen students? social and emotional learning. Objective: This study aimed to explore student-perceived usability of VR simulation in three health care education programs in Norway. Methods: Students from one university participated in a VR simulation program. Of these, students in social education (n=74), nursing (n=45), and occupational therapy (n=27) completed a questionnaire asking about their perceptions of the usability of the VR simulation and the related learning activities. Differences between groups of students were examined with Pearson chi-square tests and with 1-way ANOVA. Qualitative content analysis was used to analyze data from open-ended questions. Results: The nursing students were most satisfied with the usability of the VR simulation, while the occupational therapy students were least satisfied. The nursing students had more often prior experience from using VR technology (60%), while occupational therapy students less often had prior experience (37%). Nevertheless, high mean scores indicated that the students experienced the VR simulation and the related learning activities as very useful. The results also showed that by using realistic scenarios in VR simulation, health care students can be prepared for complex clinical situations in a safe environment. Also, group debriefing sessions are a vital part of the learning process that enhance active involvement with peers. Conclusions: VR simulation has promise and potential as a pedagogical tool in health care education, especially for training soft skills relevant for clinical practice, such as communication, decision-making, time management, and critical thinking. UR - https://mededu.jmir.org/2024/1/e56844 UR - http://dx.doi.org/10.2196/56844 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56844 ER - TY - JOUR AU - Karabacak, Mert AU - Ozcan, Zeynep AU - Ozkara, Berksu Burak AU - Furkan, Sude Zeynep AU - Bisdas, Sotirios PY - 2024/10/31 TI - A Pilot Project to Promote Research Competency in Medical Students Through Journal Clubs: Mixed Methods Study JO - JMIR Med Educ SP - e51173 VL - 10 KW - medical student KW - research KW - peer education KW - student society KW - journal club KW - skills KW - scientific investigation KW - undergraduate KW - student-led KW - initiative KW - resources KW - research training KW - competency KW - continuing education KW - research improvement KW - motivation KW - mentor KW - mentorship KW - medical education N2 - Background: Undergraduate medical students often lack hands-on research experience and fundamental scientific research skills, limiting their exposure to the practical aspects of scientific investigation. The Cerrahpasa Neuroscience Society introduced a program to address this deficiency and facilitate student-led research. Objective: The primary goal of this initiative was to enhance medical students? research output by enabling them to generate and publish peer-reviewed papers within the framework of this pilot project. The project aimed to provide an accessible, global model for research training through structured journal clubs, mentorship from experienced peers, and resource access. Methods: In January 2022, a total of 30 volunteer students from various Turkish medical schools participated in this course-based undergraduate research experience program. Students self-organized into 2 groups according to their preferred study type: original research or systematic review. Two final-year students with prior research experience led the project, developing training modules using selected materials. The project was implemented entirely online, with participants completing training modules before using their newly acquired theoretical knowledge to perform assigned tasks. Results: Based on student feedback, the project timeline was adjusted to allow for greater flexibility in meeting deadlines. Despite these adjustments, participants successfully completed their tasks, applying the theoretical knowledge they had gained to their respective assignments. As of April 2024, the initiative has culminated in 3 published papers and 3 more under peer review. The project has also seen an increase in student interest in further involvement and self-paced learning. Conclusions: This initiative leverages globally accessible resources for research training, effectively fostering research competency among participants. It has successfully demonstrated the potential for undergraduates to contribute to medical research output and paved the way for a self-sustaining, student-led research program. Despite some logistical challenges, the project provided valuable insights for future implementations, showcasing the potential for students to engage in meaningful, publishable research. UR - https://mededu.jmir.org/2024/1/e51173 UR - http://dx.doi.org/10.2196/51173 ID - info:doi/10.2196/51173 ER - TY - JOUR AU - Khamisy-Farah, Rola AU - Biras, Eden AU - Shehadeh, Rabie AU - Tuma, Ruba AU - Atwan, Hisham AU - Siri, Anna AU - Converti, Manlio AU - Chirico, Francesco AU - Szarpak, ?ukasz AU - Biz, Carlo AU - Farah, Raymond AU - Bragazzi, Nicola PY - 2024/10/8 TI - Gender and Sexuality Awareness in Medical Education and Practice: Mixed Methods Study JO - JMIR Med Educ SP - e59009 VL - 10 KW - gender medicine KW - medical education KW - clinical practice KW - gender-sensitive care KW - gender awareness KW - sexuality awareness KW - awareness KW - medical education and practice KW - healthcare KW - patient outcomes KW - patient KW - patients KW - medical professionals KW - training KW - educational interventions KW - status-based KW - survey KW - effectiveness KW - medical workforce N2 - Background: The integration of gender and sexuality awareness in health care is increasingly recognized as vital for patient outcomes. Despite this, there is a notable lack of comprehensive data on the current state of physicians? training and perceptions in these areas, leading to a gap in targeted educational interventions and optimal health care delivery. Objective: The study?s aim was to explore the experiences and perceptions of attending and resident physicians regarding the inclusion of gender and sexuality content in medical school curricula and professional practice in Israel. Methods: This cross-sectional survey targeted a diverse group of physicians across various specializations and experience levels. Distributed through Israeli Medical Associations and professional networks, it included sections on experiences with gender and sexuality content, perceptions of knowledge, the impact of medical school curricula on professional capabilities, and views on integrating gender medicine in medical education. Descriptive and correlational analyses, along with gender-based and medical status-based comparisons, were used, complemented, and enhanced by qualitative analysis of participants? replies. Results: The survey, encompassing 189 respondents, revealed low-to-moderate exposure to gender and sexuality content in medical school curricula, with a similar perception of preparedness. A need for more comprehensive training was widely recognized. The majority valued training in these areas for enhancing professional capabilities, identifying 10 essential gender-related knowledge areas. The preference for integrating gender medicine throughout medical education was significant. Gender-based analysis indicated variations in exposure and perceptions. Conclusions: The study highlights a crucial need for the inclusion of gender and sexuality awareness in medical education and practice. It suggests the necessity for curriculum development, targeted training programs, policy advocacy, mentorship initiatives, and research to evaluate the effectiveness of these interventions. The findings serve as a foundation for future directions in medical education, aiming for a more inclusive, aware, and prepared medical workforce. UR - https://mededu.jmir.org/2024/1/e59009 UR - http://dx.doi.org/10.2196/59009 UR - http://www.ncbi.nlm.nih.gov/pubmed/39152652 ID - info:doi/10.2196/59009 ER - TY - JOUR AU - Carrillo, Irene AU - Skoumalová, Ivana AU - Bruus, Ireen AU - Klemm, Victoria AU - Guerra-Paiva, Sofia AU - Kne?evi?, Bojana AU - Jankauskiene, Augustina AU - Jocic, Dragana AU - Tella, Susanna AU - Buttigieg, C. Sandra AU - Srulovici, Einav AU - Madarasová Gecková, Andrea AU - Põlluste, Kaja AU - Strametz, Reinhard AU - Sousa, Paulo AU - Odalovic, Marina AU - Mira, Joaquín José PY - 2024/10/7 TI - Psychological Safety Competency Training During the Clinical Internship From the Perspective of Health Care Trainee Mentors in 11 Pan-European Countries: Mixed Methods Observational Study JO - JMIR Med Educ SP - e64125 VL - 10 KW - psychological safety KW - speaking up KW - professional competence KW - patient safety KW - education KW - adverse event N2 - Background: In the field of research, psychological safety has been widely recognized as a contributing factor to improving the quality of care and patient safety. However, its consideration in the curricula and traineeship pathways of residents and health care students is scarce. Objective: This study aims to determine the extent to which health care trainees acquire psychological safety competencies during their internships in clinical settings and identify what measures can be taken to promote their learning. Methods: A mixed methods observational study based on a consensus conference and an open-ended survey among a sample of health care trainee mentors from health care institutions in a pan-European context was conducted. First, we administered an ad hoc questionnaire to assess the perceived degree of acquisition or implementation and significance of competencies (knowledge, attitudes, and skills) and institutional interventions in psychological safety. Second, we asked mentors to propose measures to foster among trainees those competencies that, in the first phase of the study, obtained an average acquisition score of <3.4 (scale of 1-5). A content analysis of the information collected was carried out, and the spontaneity of each category and theme was determined. Results: In total, 173 mentors from 11 pan-European countries completed the first questionnaire (response rate: 173/256, 67.6%), of which 63 (36.4%) participated in the second consultation. The competencies with the lowest acquisition level were related to warning a professional that their behavior posed a risk to the patient, managing their possible bad reaction, and offering support to a colleague who becomes a second victim. The mentors? proposals for improvement of this competency gap referred to training in communication skills and patient safety, safety culture, work climate, individual attitudes, a reference person for trainees, formal incorporation into the curricula of health care degrees and specialization pathways, specific systems and mechanisms to give trainees a voice, institutional risk management, regulations, guidelines and standards, supervision, and resources to support trainees. In terms of teaching methodology, the mentors recommended innovative strategies, many of them based on technological tools or solutions, including videos, seminars, lectures, workshops, simulation learning or role-playing with or without professional actors, case studies, videos with practical demonstrations or model situations, panel discussions, clinical sessions for joint analysis of patient safety incidents, and debriefings to set and discuss lessons learned. Conclusions: This study sought to promote psychological safety competencies as a formal part of the training of future health care professionals, facilitating the translation of international guidelines into practice and clinical settings in the pan-European context. UR - https://mededu.jmir.org/2024/1/e64125 UR - http://dx.doi.org/10.2196/64125 UR - http://www.ncbi.nlm.nih.gov/pubmed/39374073 ID - info:doi/10.2196/64125 ER - TY - JOUR AU - Gil-Hernández, Eva AU - Carrillo, Irene AU - Guilabert, Mercedes AU - Bohomol, Elena AU - Serpa, C. Piedad AU - Ribeiro Neves, Vanessa AU - Maluenda Martínez, Maria AU - Martin-Delgado, Jimmy AU - Pérez-Esteve, Clara AU - Fernández, César AU - Mira, Joaquín José PY - 2024/7/18 TI - Development and Implementation of a Safety Incident Report System for Health Care Discipline Students During Clinical Internships: Observational Study JO - JMIR Med Educ SP - e56879 VL - 10 KW - reporting systems KW - education KW - medical KW - nursing KW - undergraduate KW - patient safety N2 - Background: Patient safety is a fundamental aspect of health care practice across global health systems. Safe practices, which include incident reporting systems, have proven valuable in preventing the recurrence of safety incidents. However, the accessibility of this tool for health care discipline students is not consistent, limiting their acquisition of competencies. In addition, there is no tools to familiarize students with analyzing safety incidents. Gamification has emerged as an effective strategy in health care education. Objective: This study aims to develop an incident reporting system tailored to the specific needs of health care discipline students, named Safety Incident Report System for Students. Secondary objectives included studying the performance of different groups of students in the use of the platform and training them on the correct procedures for reporting. Methods: This was an observational study carried out in 3 phases. Phase 1 consisted of the development of the web-based platform and the incident registration form. For this purpose, systems already developed and in use in Spain were taken as a basis. During phase 2, a total of 223 students in medicine and nursing with clinical internships from universities in Argentina, Brazil, Colombia, Ecuador, and Spain received an introductory seminar and were given access to the platform. Phase 3 ran in parallel and involved evaluation and feedback of the reports received as well as the opportunity to submit the students? opinion on the process. Descriptive statistics were obtained to gain information about the incidents, and mean comparisons by groups were performed to analyze the scores obtained. Results: The final form was divided into 9 sections and consisted of 48 questions that allowed for introducing data about the incident, its causes, and proposals for an improvement plan. The platform included a personal dashboard displaying submitted reports, average scores, progression, and score rankings. A total of 105 students participated, submitting 147 reports. Incidents were mainly reported in the hospital setting, with complications of care (87/346, 25.1%) and effects of medication or medical products (82/346, 23.7%) being predominant. The most repeated causes were related confusion, oversight, or distractions (49/147, 33.3%) and absence of process verification (44/147, 29.9%). Statistically significant differences were observed between the mean final scores received by country (P<.001) and sex (P=.006) but not by studies (P=.47). Overall, participants rated the experience of using the Safety Incident Report System for Students positively. Conclusions: This study presents an initial adaptation of reporting systems to suit the needs of students, introducing a guided and inspiring framework that has garnered positive acceptance among students. Through this endeavor, a pathway toward a safety culture within the faculty is established. A long-term follow-up would be desirable to check the real benefits of using the tool during education. Trial Registration: Trial Registration: ClinicalTrials.gov NCT05350345; https://clinicaltrials.gov/study/NCT05350345 UR - https://mededu.jmir.org/2024/1/e56879 UR - http://dx.doi.org/10.2196/56879 UR - http://www.ncbi.nlm.nih.gov/pubmed/39024005 ID - info:doi/10.2196/56879 ER - TY - JOUR AU - Tolentino, Raymond AU - Baradaran, Ashkan AU - Gore, Genevieve AU - Pluye, Pierre AU - Abbasgholizadeh-Rahimi, Samira PY - 2024/7/18 TI - Curriculum Frameworks and Educational Programs in AI for Medical Students, Residents, and Practicing Physicians: Scoping Review JO - JMIR Med Educ SP - e54793 VL - 10 KW - artificial intelligence KW - machine learning KW - curriculum KW - framework KW - medical education KW - review N2 - Background: The successful integration of artificial intelligence (AI) into clinical practice is contingent upon physicians? comprehension of AI principles and its applications. Therefore, it is essential for medical education curricula to incorporate AI topics and concepts, providing future physicians with the foundational knowledge and skills needed. However, there is a knowledge gap in the current understanding and availability of structured AI curriculum frameworks tailored for medical education, which serve as vital guides for instructing and facilitating the learning process. Objective: The overall aim of this study is to synthesize knowledge from the literature on curriculum frameworks and current educational programs that focus on the teaching and learning of AI for medical students, residents, and practicing physicians. Methods: We followed a validated framework and the Joanna Briggs Institute methodological guidance for scoping reviews. An information specialist performed a comprehensive search from 2000 to May 2023 in the following bibliographic databases: MEDLINE (Ovid), Embase (Ovid), CENTRAL (Cochrane Library), CINAHL (EBSCOhost), and Scopus as well as the gray literature. Papers were limited to English and French languages. This review included papers that describe curriculum frameworks for teaching and learning AI in medicine, irrespective of country. All types of papers and study designs were included, except conference abstracts and protocols. Two reviewers independently screened the titles and abstracts, read the full texts, and extracted data using a validated data extraction form. Disagreements were resolved by consensus, and if this was not possible, the opinion of a third reviewer was sought. We adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist for reporting the results. Results: Of the 5104 papers screened, 21 papers relevant to our eligibility criteria were identified. In total, 90% (19/21) of the papers altogether described 30 current or previously offered educational programs, and 10% (2/21) of the papers described elements of a curriculum framework. One framework describes a general approach to integrating AI curricula throughout the medical learning continuum and another describes a core curriculum for AI in ophthalmology. No papers described a theory, pedagogy, or framework that guided the educational programs. Conclusions: This review synthesizes recent advancements in AI curriculum frameworks and educational programs within the domain of medical education. To build on this foundation, future researchers are encouraged to engage in a multidisciplinary approach to curriculum redesign. In addition, it is encouraged to initiate dialogues on the integration of AI into medical curriculum planning and to investigate the development, deployment, and appraisal of these innovative educational programs. International Registered Report Identifier (IRRID): RR2-10.11124/JBIES-22-00374 UR - https://mededu.jmir.org/2024/1/e54793 UR - http://dx.doi.org/10.2196/54793 UR - http://www.ncbi.nlm.nih.gov/pubmed/39023999 ID - info:doi/10.2196/54793 ER - TY - JOUR AU - Aqib, Ayma AU - Fareez, Faiha AU - Assadpour, Elnaz AU - Babar, Tubba AU - Kokavec, Andrew AU - Wang, Edward AU - Lo, Thomas AU - Lam, Jean-Paul AU - Smith, Christopher PY - 2024/6/20 TI - Development of a Novel Web-Based Tool to Enhance Clinical Skills in Medical Education JO - JMIR Med Educ SP - e47438 VL - 10 KW - medical education KW - objective structured clinical examination KW - OSCE KW - e-OSCE KW - Medical Council of Canada KW - MCC KW - virtual health KW - exam KW - examination KW - utility KW - usability KW - online learning KW - e-learning KW - medical student KW - medical students KW - clinical practice KW - clinical skills KW - clinical skill KW - OSCE tool UR - https://mededu.jmir.org/2024/1/e47438 UR - http://dx.doi.org/10.2196/47438 ID - info:doi/10.2196/47438 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 - Cardoso Pinto, M. Alexandra AU - Soussi, Daniella AU - Qasim, Subaan AU - Dunin-Borkowska, Aleksandra AU - Rupasinghe, Thiara AU - Ubhi, Nicholas AU - Ranasinghe, Lasith PY - 2024/4/23 TI - The Use of Animations Depicting Cardiac Electrical Activity to Improve Confidence in Understanding of Cardiac Pathology and Electrocardiography Traces Among Final-Year Medical Students: Nonrandomized Controlled Trial JO - JMIR Med Educ SP - e46507 VL - 10 KW - medical education KW - cardiology KW - technology KW - clinical skills KW - cardiac KW - cardiac electrical activity KW - ECG KW - mixed methods study KW - students KW - education KW - medical professionals KW - development KW - web-based tutorial KW - teaching KW - cardiovascular KW - learning KW - electrocardiography N2 - Background: Electrocardiography (ECG) interpretation is a fundamental skill for medical students and practicing medical professionals. Recognizing ECG pathologies promptly allows for quick intervention, especially in acute settings where urgent care is needed. However, many medical students find ECG interpretation and understanding of the underlying pathology challenging, with teaching methods varying greatly. Objective: This study involved the development of novel animations demonstrating the passage of electrical activity for well-described cardiac pathologies and showcased them alongside the corresponding live ECG traces during a web-based tutorial for final-year medical students. We aimed to assess whether the animations improved medical students? confidence in visualizing cardiac electrical activity and ECG interpretation, compared to standard ECG teaching methods. Methods: Final-year medical students at Imperial College London attended a web-based tutorial demonstrating the 7 animations depicting cardiac electrical activity and the corresponding ECG trace. Another tutorial without the animations was held to act as a control. Students completed a questionnaire assessing their confidence in interpreting ECGs and visualizing cardiovascular electrical transmission before and after the tutorial. Intervention-arm participants were also invited to a web-based focus group to explore their experiences of past ECG teaching and the tutorial, particularly on aspects they found helpful and what could be further improved in the tutorial and animations. Wilcoxon signed-rank tests and Mann-Whitney U tests were used to assess the statistical significance of any changes in confidence. Focus group transcripts were analyzed using inductive thematic analysis. Results: Overall, 19 students attended the intervention arm, with 15 (79%) completing both the pre- and posttutorial questionnaires and 15 (79%) participating in focus groups, whereas 14 students attended the control arm, with 13 (93%) completing both questionnaires. Median confidence in interpreting ECGs in the intervention arm increased after the tutorial (2, IQR 1.5-3.0 vs 3, IQR 3-4.5; P<.001). Improvement was seen in both confidence in reviewing or diagnosing cardiac rhythms and the visualization of cardiac electrical activity. However, there was no significant difference between the intervention and control arms, for all pathologies (all P>.05). The main themes from the thematic analysis were that ECGs are a complex topic and past ECG teaching has focused on memorizing traces; the visualizations enabled deeper understanding of cardiac pathology; and ECG learning requires repetition, and clinical links remain essential. Conclusions: This study highlights the value of providing concise explanations of the meaning and pathophysiology behind ECG traces, both visually and verbally. ECG teaching that incorporates relevant pathophysiology, alongside vignettes with discussions regarding investigations and management options, is likely more helpful to students than practices based solely on pattern recognition. Although the animations supported student learning, the key element was the tutor?s explanations. These animations may be more helpful as a supplement to teaching, for instance, as open-access videos. UR - https://mededu.jmir.org/2024/1/e46507 UR - http://dx.doi.org/10.2196/46507 ID - info:doi/10.2196/46507 ER - TY - JOUR AU - Dsouza, Maria Jeanne PY - 2024/4/15 TI - A Student?s Viewpoint on ChatGPT Use and Automation Bias in Medical Education JO - JMIR Med Educ SP - e57696 VL - 10 KW - AI KW - artificial intelligence KW - ChatGPT KW - medical education UR - https://mededu.jmir.org/2024/1/e57696 UR - http://dx.doi.org/10.2196/57696 ID - info:doi/10.2196/57696 ER - TY - JOUR AU - Thiesmeier, Robert AU - Orsini, Nicola PY - 2024/4/15 TI - Rolling the DICE (Design, Interpret, Compute, Estimate): Interactive Learning of Biostatistics With Simulations JO - JMIR Med Educ SP - e52679 VL - 10 KW - learning statistics KW - Monte Carlo simulation KW - simulation-based learning KW - survival analysis KW - Weibull UR - https://mededu.jmir.org/2024/1/e52679 UR - http://dx.doi.org/10.2196/52679 UR - http://www.ncbi.nlm.nih.gov/pubmed/38619866 ID - info:doi/10.2196/52679 ER - TY - JOUR AU - Burch, Vanessa AU - McGuire, Jessica AU - Buch, Eric AU - Sathekge, Mike AU - M'bouaffou, Francis AU - Senkubuge, Flavia AU - Fagan, Johannes PY - 2024/3/6 TI - Feasibility and Acceptability of Web-Based Structured Oral Examinations for Postgraduate Certification: Mixed Methods Preliminary Evaluation JO - JMIR Form Res SP - e40868 VL - 8 KW - web-based certification examinations KW - web-based structured oral examinations KW - medical education KW - specialist and subspecialist examinations KW - structured oral examinations KW - Colleges of Medicine of South Africa N2 - Background: The COVID-19 pandemic disrupted postgraduate certification examinations globally. The Colleges of Medicine of South Africa continued hosting certification examinations through the pandemic. This was achieved by effecting a rapid transition from in-person to web-based certification examinations. Objective: This formative evaluation explored candidates? acceptability of web-based structured oral examinations (SOEs) hosted via Zoom (Zoom Communications Inc). We also reported the audiovisual quality and technical challenges encountered while using Zoom and candidates? overall experience with these examinations conducted during the early part of the COVID-19 pandemic. Additionally, performance in web-based certification examinations was compared with previous in-person certification examinations. Methods: This mixed methods, single-arm evaluation anonymously gathered candidates? perceptions of web-based SOE acceptability, audiovisual quality, and overall experience with Zoom using a web-based survey. Pass rates of web-based and previous in-person certification examinations were compared using chi-square tests, with a Yates correction. A thematic analysis approach was adopted for qualitative data. Results: Between June 2020 and June 2021, 3105 candidates registered for certification examinations, 293 (9.4%) withdrew, 2812 (90.6%) wrote, and 2799 (99.9%) passed, and 1525 (54.2%) were invited to a further web-based SOE. Examination participation was 96.2% (n=1467). During the first web-based examination cycle (2020), 542 (87.1%) of 622 web-based SOE candidates completed the web-based survey. They reported web-based SOEs as fair (374/542, 69%) and adequately testing their clinical reasoning and insight (396/542, 73.1%). Few would have preferred real patient encounters (173/542, 31.9%) or in-person oral examinations (152/542, 28%). Most found Zoom acceptable (434/542, 80%) and fair (396/542, 73.1%) for hosting web-based SOEs. SOEs resulted in financial (434/542, 80%) and time (428/542, 79%) savings for candidates. Many (336/542, 62%) supported the ongoing use of web-based certification examinations. Only 169 technical challenges in using Zoom were reported, which included connectivity-related issues, poor audio quality, and poor image quality. The thematic analysis identified 4 themes of positive and negative experiences related to web-based SOE station design and content, examination station environment, examiner-candidate interactions, and personal benefits for candidates. Our qualitative analysis identified 10 improvements for future web-based SOEs. Candidates achieved high pass rates in web-based certification examinations in 2020 (1583/1732, 91.39%) and 2021 (850/1067, 79.66%). These were significantly higher (2020: N=8635; ?21=667; P<.001; 2021: N=7988; ?21=178; P<.001) than the previous in-person certification examination pass rate of 58.23% (4030/6921; 2017-2019). Conclusions: Web-based SOEs conducted by the Colleges of Medicine of South Africa during the COVID-19 pandemic were well received by candidates, and few technical difficulties were encountered while using Zoom. Better performance was observed in web-based examinations than in previous in-person certification examinations. These early findings support the ongoing use of this assessment method. UR - https://formative.jmir.org/2024/1/e40868 UR - http://dx.doi.org/10.2196/40868 UR - http://www.ncbi.nlm.nih.gov/pubmed/38064633 ID - info:doi/10.2196/40868 ER - TY - JOUR AU - Martínez-Gaitero, Carlos AU - Dennerlein, Maximilian Sebastian AU - Dobrowolska, Beata AU - Fessl, Angela AU - Moreno-Martínez, Daniel AU - Herbstreit, Stephanie AU - Peffer, Gilbert AU - Cabrera, Esther AU - PY - 2024/2/8 TI - Connecting Actors With the Introduction of Mobile Technology in Health Care Practice Placements (4D Project): Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e53284 VL - 13 KW - practice-based learning KW - practice placement KW - technology enhanced learning KW - mobile learning KW - co-design KW - cocreation KW - higher education KW - health professionals KW - health students. N2 - Background: The learning process in clinical placements for health care students is a multifaceted endeavor that engages numerous actors and stakeholders, including students, clinical tutors, link teachers, and academic assessors. Successfully navigating this complex process requires the implementation of tasks and mentorships that are synchronized with educational and clinical processes, seamlessly embedded within their respective contexts. Given the escalating number of students and the rising demand for health care services from the general population, it becomes imperative to develop additional tools that support the learning process. These tools aim to simplify day-to-day clinical practice, allowing a concentrated focus on value-based activities. This paper introduces a project funded by the European Commission that involves 5 European countries. The project?s objective is to comprehensively outline the entire process of development and ultimately implement mobile technology in practice placements. The project tackles the existing gap by constructing tailored mobile apps designed for students, teachers, tutors, and supervisors within each participating organization. This approach leverages practice-based learning, mobile technology, and technology adoption to enhance the overall educational experience. Objective: This study aims to introduce mobile technology in clinical practice placements with the goal of facilitating and enhancing practice-based learning. The objective is to improve the overall effectiveness of the process for all stakeholders involved. Methods: The ?4D in the Digitalization of Learning in Practice Placement? (4D Project) will use a mixed methods research design, encompassing 3 distinct study phases: phase 1 (preliminary research), which incorporates focus groups and a scoping review, to define the problem, identify necessities, and analyze contextual factors; phase 2 (collaborative app development), which involves researchers and prospective users working together to cocreate and co-design tailored apps; and phase 3, which involves feasibility testing of these mobile apps within practice settings. Results: The study?s potential impact will primarily focus on improving communication and interaction processes, fostering connections among stakeholders in practice placements, and enhancing the assessment of training needs. The literature review and focus groups will play a crucial role in identifying barriers, facilitators, and factors supporting the integration of mobile technology in clinical education. The cocreation process of mobile learning apps will reveal the core values and needs of various stakeholders, including students, teachers, and health care professionals. This process also involves adapting and using mobile apps to meet the specific requirements of practice placements. A pilot study aimed at validating the app will test and assess mobile technology in practice placements. The study will determine results related to usability and design, learning outcomes, student engagement, communication among stakeholders, user behavior, potential issues, and compliance with regulations. Conclusions: Health care education, encompassing disciplines such as medicine, nursing, midwifery, and others, confronts evolving challenges in clinical training. Essential to addressing these challenges is bridging the gap between health care institutions and academic settings. The introduction of a new digital tool holds promise for empowering health students and mentors in effectively navigating the intricacies of the learning process. International Registered Report Identifier (IRRID): DERR1-10.2196/53284 UR - https://www.researchprotocols.org/2024/1/e53284 UR - http://dx.doi.org/10.2196/53284 UR - http://www.ncbi.nlm.nih.gov/pubmed/38329786 ID - info:doi/10.2196/53284 ER - TY - JOUR AU - Khodabakhshian, Nairy AU - Gaeul Lee, Kyla AU - Marawi, Tulip AU - Sorkhou, Maryam AU - Vyravanathan, Sobiga AU - Harnett, Nicole PY - 2024/2/1 TI - Virtual Reality for Developing Patient-Facing Communication Skills in Medical and Graduate Education: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e53901 VL - 13 KW - communication KW - medical education KW - patient-facing KW - scoping review KW - technology KW - virtual reality N2 - Background: Clinician-patient communication is an integral component in providing quality medical care. However, research on clinician-patient communication has shown overall patient discontent with provider communication skills. While virtual reality (VR) is readily used for procedural-based learning in medical education, its potential for teaching patient-facing communication skills remains unexplored. This scoping review aims to evaluate the effectiveness and feasibility of VR applications used for patient-facing communication skills development in medical education. Objective: The primary objective is to synthesize and evaluate the effectiveness of available VR tools and applications used for patient-facing communication skills development in medical education. The secondary objectives are to (1) assess the feasibility of adapting VR applications to develop patient-facing communication skills in medical education and (2) provide an overview of the challenges associated with adapting VR applications to develop patient-facing communication skills in medical education. Methods: A total of 4 electronic databases (ERIC, Embase, PubMed, and MEDLINE) were searched for primary peer-reviewed articles published through April 11, 2023. Articles evaluating the implementation of non-, semi-, and fully immersive VR training for patient- or caregiver-facing communication skills training provided to graduate, medical, or other allied health care professions students were included. Studies that assessed augmented reality, mixed reality, artificial intelligence, or VR for non?communication-based training were excluded. Study selection will include a title, abstract, and full-text screening by 4 authors. Data from eligible studies will be extracted and entered into a database and presented in tabular format. Findings will be reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. Results: As of April 11, 2023, the search strategy has been confirmed and the search has been completed. We are currently at the title and abstract screening stage. Once complete, the articles will undergo full-text screening according to eligibility criteria as described in the methods. Conclusions: The findings of this review will inform the development of a graduate-level clinical skills research course within the Institute of Medical Science graduate department at the University of Toronto. It is also expected that these findings will be of interest to other health care?specific faculties inside and beyond our institution. Further, our scoping review will summarize the limited field of literature on VR use in medical communications training and identify areas for future inquiry. International Registered Report Identifier (IRRID): DERR1-10.2196/53901 UR - https://www.researchprotocols.org/2024/1/e53901 UR - http://dx.doi.org/10.2196/53901 UR - http://www.ncbi.nlm.nih.gov/pubmed/38300671 ID - info:doi/10.2196/53901 ER - TY - JOUR AU - Alkuran, Oqba AU - Al-Mehaisen, Lama AU - Abu Mahfouz, Ismaiel AU - Al-Kuran, Lena AU - Asali, Fida AU - Khamees, Almu?atasim AU - AL-Shatanawi, Tariq AU - Jaber, Hatim PY - 2023/12/5 TI - Distance Electronic Learning Strategy in Medical Teaching During the COVID-19 Pandemic: Cross-Sectional Survey Study JO - JMIR Med Educ SP - e42354 VL - 9 KW - COVID-19 KW - distant electronic learning KW - medical KW - medicine KW - school KW - medical school KW - medical education KW - clinical skill KW - teaching hospital KW - questionnaire KW - distance learning KW - distance education KW - web-based education KW - web-based learning KW - medical student N2 - Background: Teaching hospitals have been regarded as the primary settings where doctors teach and practice high-quality medicine, as well as where medical students learn the profession and acquire their initial clinical skills. A percentage of instruction is now done over the internet or via electronic techniques. The present COVID-19 epidemic has pushed distance electronic learning (DEL) to the forefront of education at all levels, including medical institutions. Objective: This study aimed to observe how late-stage medical students felt about DEL, which was put in place during the recent COVID-19 shutdown in Jordan. Methods: We conducted a prospective, cross-sectional, web-based, questionnaire-based research study during the COVID-19 pandemic lockdown between March 15 and May 1, 2020. During this period, all medical schools in Jordan shifted to DEL. Results: A total of 380 students responded to a request to fill out the questionnaire, of which 256 completed the questionnaire. The data analysis showed that 43.6% (n=112) of respondents had no DEL experience, and 53.1% (n=136)of respondents perceived the DEL method as user-friendly. On the other hand, 64.1% (n=164) of students strongly believed that DEL cannot substitute traditional clinical teaching. There was a significant positive correlation between the perception of user-friendliness and the clarity of the images and texts used. Moreover, there was a strong positive correlation between the perception of sound audibility and confidence in applying knowledge gained through DEL to clinical practice. Conclusions: DEL is a necessary and important tool in modern medical education, but it should be used as an auxiliary approach in the clinical setting since it cannot replace conventional personal instruction. UR - https://mededu.jmir.org/2023/1/e42354 UR - http://dx.doi.org/10.2196/42354 UR - http://www.ncbi.nlm.nih.gov/pubmed/38051556 ID - info:doi/10.2196/42354 ER - TY - JOUR AU - Hazelton, Lara AU - da Luz Dias, Raquel AU - Esliger, Mandy AU - Tibbo, Philip AU - Sinha, Nachiketa AU - Njoku, Anthony AU - Satyanarayana, Satyendra AU - Siddhartha, Sanjay AU - Alexiadis-Brown, Peggy AU - Rahman, Faisal AU - Maguire, Hugh AU - Gray, Gerald AU - Bosma, Mark AU - Parker, Deborah AU - Connolly, Owen AU - Raji, Adewale AU - Manning, Alexandra AU - Bagnell, Alexa AU - Israel Opoku Agyapong, Vincent PY - 2023/11/27 TI - Exploring Current Practices, Needs, and Barriers for Expanding Distributed Medical Education and Scholarship in Psychiatry: Protocol for an Environmental Scan Using a Formal Information Search Approach and Explanatory Design JO - JMIR Res Protoc SP - e46835 VL - 12 KW - distributed learning sites KW - medical education KW - psychiatry KW - environmental scan KW - needs assessment KW - strategic plan KW - distributed medical education KW - rural area KW - physician KW - mixed methods approach KW - education program N2 - Background: Distributed medical education (DME) offers manifold benefits, such as increased training capacity, enhanced clinical learning, and enhanced rural physician recruitment. Engaged faculty are pivotal to DME's success, necessitating efforts from the academic department to promote integration into scholarly and research activities. Environmental scanning has been used to gather, analyze, and apply information for strategic planning purposes. It helps organizations identify current practices, assess needs and barriers, and respond to emerging risks and opportunities. There are process models and conceptual frameworks developed for environmental scanning in the business and educational sectors. However, the literature lacks methodological direction on how to go about designing and implementing this strategy to guide research and practice in DME, especially in the psychiatry field. Objective: This paper presents a protocol for an environmental scanning that aims to understand current practices and identify needs and barriers that must be addressed to facilitate the integration of psychiatrists from the Dalhousie University Faculty of Medicine?s distributed education sites in Nova Scotia and New Brunswick into the Department of Psychiatry, contributing for the expansion of DME in both provinces and informing strategic planning and decision-making within the organization. Methods: This protocol adopts an innovative approach combining a formal information search and an explanatory design that includes quantitative and qualitative data. About 120 psychiatrists from 8 administrative health zones of both provinces will be invited to complete an anonymous web-based survey with questions about demographics, participants' experience and interest in undergraduate, postgraduate, and continuing medical education, research and scholarly activities, quality improvement, and knowledge translation. Focus group sessions will be conducted with a purposive sample of psychiatrists to collect qualitative data on their perspectives on the expansion of DME. Results: Results are expected within 6 months of data collection and will inform policy options for expanding Dalhousie University?s psychiatry residency and fellowship programs using the infrastructure and human resources at distributed learning sites, leveraging opportunities regionally, especially in rural areas. Conclusions: This paper proposes a comprehensive environmental scan procedure adapted from existing approaches. It does this by collecting important characteristics that affect psychiatrists' desire to be involved with research and scholarly activities, which is crucial for the DME expansion. Furthermore, its concordance with the literature facilitates interpretation and comparison. The protocol's new method also fills DME information gaps, allowing one to identify insights and patterns that may shape psychiatric education. This environmental scan's results will answer essential questions about how training programs could involve therapists outside the academic core and make the most of training experiences in semiurban and rural areas. This could help other psychiatry and medical units outside tertiary care establish residency and fellowship programs. International Registered Report Identifier (IRRID): DERR1-10.2196/46835 UR - https://www.researchprotocols.org/2023/1/e46835 UR - http://dx.doi.org/10.2196/46835 UR - http://www.ncbi.nlm.nih.gov/pubmed/38010790 ID - info:doi/10.2196/46835 ER - TY - JOUR AU - Alzoubi, Hiba AU - Karasneh, Reema AU - Irshaidat, Sara AU - Abuelhaija, Yussuf AU - Abuorouq, Saleh AU - Omeish, Haya AU - Daromar, Shrouq AU - Makhadmeh, Naheda AU - Alqudah, Mohammad AU - Abuawwad, T. Mohammad AU - Taha, J. Mohammad J. AU - Baniamer, Ansam AU - Abu Serhan, Hashem PY - 2023/11/24 TI - Exploring the Use of YouTube as a Pathology Learning Tool and Its Relationship With Pathology Scores Among Medical Students: Cross-Sectional Study JO - JMIR Med Educ SP - e45372 VL - 9 KW - pathology KW - medical students KW - YouTube KW - social media KW - medical education KW - online resources N2 - Background: YouTube is considered one of the most popular sources of information among college students. Objective: This study aimed to explore the use of YouTube as a pathology learning tool and its relationship with pathology scores among medical students at Jordanian public universities. Methods: This cross-sectional, questionnaire-based study included second-year to sixth-year medical students from 6 schools of medicine in Jordan. The questionnaire was distributed among the students using social platforms over a period of 2 months extending from August 2022 to October 2022. The questionnaire included 6 attributes. The first section collected demographic data, and the second section investigated the general use of YouTube and recorded material. The remaining 4 sections targeted the participants who used YouTube to learn pathology including using YouTube for pathology-related content. Results: As of October 2022, 699 students were enrolled in the study. More than 60% (422/699, 60.4%) of the participants were women, and approximately 50% (354/699, 50.6%) were second-year students. The results showed that 96.5% (675/699) of medical students in Jordan were using YouTube in general and 89.1% (623/699) were using it as a source of general information. YouTube use was associated with good and very good scores among the users. In addition, 82.3% (575/699) of medical students in Jordan used YouTube as a learning tool for pathology in particular. These students achieved high scores, with 428 of 699 (61.2%) students scoring above 70%. Most participants (484/699, 69.2%) reported that lectures on YouTube were more interesting than classic teaching and the lectures could enhance the quality of learning (533/699, 76.3%). Studying via YouTube videos was associated with higher odds (odds ratio [OR] 3.86, 95% CI 1.33-11.18) and lower odds (OR 0.27, 95% CI 0.09-0.8) of achieving higher scores in the central nervous system and peripheral nervous system courses, respectively. Watching pathology lectures on YouTube was related to a better chance of attaining higher scores (OR 1.96, 95% CI 1.08-3.57). Surprisingly, spending more time watching pathology videos on YouTube while studying for examinations corresponded with lower performance, with an OR of 0.46 (95% CI 0.26-0.82). Conclusions: YouTube may play a role in enhancing pathology learning, and aiding in understanding, memorization, recalling information, and obtaining higher scores. Many medical students in Jordan have positive attitudes toward using YouTube as a supplementary pathology learning tool. Based on this, it is recommended that pathology instructors should explore the use of YouTube and other emerging educational tools as potential supplementary learning resources. UR - https://mededu.jmir.org/2023/1/e45372/ UR - http://dx.doi.org/10.2196/45372 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/45372 ER - TY - JOUR AU - Akhras, Aya AU - ElSaban, Mariam AU - Tamil?Selvan, Varshini AU - Alzaabi, Zain Shaika AU - Senok, Abiola? AU - Zary, Nabil AU - Ho, B. Samuel PY - 2023/11/6 TI - An Inquiry-Based Distance Learning Tool for Medical Students Under Lockdown (?COVID-19 Rounds?): Cross-Sectional Study JO - JMIR Med Educ SP - e40264 VL - 9 KW - medical education KW - COVID-19 KW - technology-enhanced learning KW - distance learning KW - student engagement KW - 5E instructional model N2 - Background: The COVID-19 pandemic presented significant challenges to both clinical practice and the delivery of medical education. Educators and learners implemented novel techniques, including distance learning and web-based rounds, while trying to stay updated with the surge of information regarding COVID-19 epidemiology, pathogenesis, and treatment. Hence, we designed and implemented a technologically enhanced course called ?COVID-19 Rounds? to educate students about the rapidly evolving pandemic. Objective: The objectives of this study are to describe a technologically enhanced course called ?COVID-19 Rounds? and evaluate the following: (1) student satisfaction and program usefulness in achieving preset objectives, (2) perceived improvement in literacy regarding the pandemic, and (3) the impact of student engagement by designing infographics and initiating COVID-19?related research projects. Methods: This is a cross-sectional study measuring the impact of the implementation of the web-based ?COVID-19 Rounds? course. This program included web-based clinical experiences with physicians on actual rounds in COVID-19 wards in the hospital, weekly updates on evolving data and new research, and engagement in student-led projects. The study population included 47 fourth-year medical students at the Mohamed Bin Rashid University of Medicine and Health Sciences in Dubai, the United Arab Emirates, who attended the course. We designed and administered a 47-item survey to assess student satisfaction, program usefulness, impact on knowledge, and student engagement. Data were collected at the end of program delivery via Microsoft Forms. Results: In total, 38 (81%) out of 47 fourth-year medical students participated in this study. The final course evaluation revealed an overall high satisfaction rate, with a mean rating of 3.9 (SD 0.94) on the 5-point Likert scale. Most students were satisfied with the course format (27/38, 71%), organization (31/38, 82%), and the learning experience (28/38, 74%) that the course offered. The course was particularly appreciated for offering evidence-based talks about aspects of the pandemic (34/38, 90%), providing weekly updates regarding emerging evidence (32/38, 84%), and enhancing understanding of the challenges of the pandemic (34/38, 90%). Satisfaction with distance learning was moderate (23/37, 62%), and a minority of students would have preferred an in-person version of the course (10/37, 27%). Student engagement in the course was high. All students participated in small group presentations of infographics of pandemic-related topics. Perceived advantages included conciseness and visual appeal, and disadvantages included the lack of detail and the time-consuming nature of infographic design, especially for students with no prior design experience. After the course ended, 27 (57%) students began research projects. This resulted in 6 abstracts presented at local meetings and 8 scientific papers published or submitted for publication. Conclusions: This inquiry-based adaptive approach to educating medical students about updates on COVID-19 via web-based learning was successful in achieving objectives and encouraging engagement in research. However, shortcomings of the course related to the lack of in-person teaching and clinical activities were also highlighted. UR - https://mededu.jmir.org/2023/1/e40264 UR - http://dx.doi.org/10.2196/40264 UR - http://www.ncbi.nlm.nih.gov/pubmed/37856734 ID - info:doi/10.2196/40264 ER - TY - JOUR AU - Bälter, Olle AU - Jemstedt, Andreas AU - Javan Abraham, Feben AU - Persson Osowski, Christine AU - Mugisha, Reuben AU - Bälter, Katarina PY - 2023/10/13 TI - Effect of Personalized Email-Based Reminders on Participants? Timeliness in an Online Education Program: Randomized Controlled Trial JO - JMIR Form Res SP - e43977 VL - 7 KW - online learning KW - personal reminders KW - timeliness KW - self-regulated learning KW - adult education KW - education KW - students KW - learning KW - email KW - online KW - tool KW - intervention KW - program N2 - Background: Postsecondary students need to be able to handle self-regulated learning and manage schedules set by instructors. This is particularly the case with online courses, as they often come with a limited number of social reminders and less information directly from the teacher compared to courses with physical presence. This may increase procrastination and reduce timeliness of the students. Reminders may be a tool to improve the timeliness of students? study behavior, but previous research shows that the effect of reminders differs between types of reminders, whether the reminder is personalized or general, and depending on the background of the students. In the worst cases, reminders can even increase procrastination. Objective: The aim of this study was to test if personalized email reminders, as compared to general email reminders, affect the time to completion of scheduled online coursework. The personalized reminders included information on which page in the online material the participants ought to be on at the present point in time and the last page they were on during their last session. The general reminders only contained the first part of this information: where they ought to be at the present point in time. Methods: Weekly email reminders were sent to all participants enrolled in an online program, which included 39 professional learners from three East African countries. All participants in the Online Education for Leaders in Nutrition and Sustainability program, which uses a question-based learning methodology, were randomly assigned to either personalized or general reminders. The structure of the study was AB-BA, so that group A received personalized reminders for the first unit, then general reminders for the rest of the course, while group B started with general reminders and received personalized reminders only in the third (and last) unit in the course. Results: In total, 585 email reminders were distributed, of which 390 were general reminders and 195 were personalized. A Bayesian mixed-effects logistic regression was used to estimate the difference in the probability of being on time with one?s studies. The probability of being on time was 14 percentage points (95% credible interval 3%-25%) higher following personalized reminders compared to that following general reminders. For a course with 100 participants, this means 14 more students would be on time. Conclusions: Personalized reminders had a greater positive effect than general reminders for a group of adults working full-time while enrolled in our online educational program. Considering how small the intervention was?adding a few words with the page number the student ought to be on to a reminder?we consider this effect fairly substantial. This intervention could be repeated manually by anyone and in large courses with some basic programming. UR - https://formative.jmir.org/2023/1/e43977 UR - http://dx.doi.org/10.2196/43977 UR - http://www.ncbi.nlm.nih.gov/pubmed/37831487 ID - info:doi/10.2196/43977 ER - TY - JOUR AU - Aksoy, Emin Mehmet AU - Özkan, Ekin Arun AU - Kitapcioglu, Dilek AU - Usseli, Tuba PY - 2023/9/28 TI - Comparing the Outcomes of Virtual Reality?Based Serious Gaming and Lecture-Based Training for Advanced Life Support Training: Randomized Controlled Trial JO - JMIR Serious Games SP - e46964 VL - 11 KW - Advanced Cardiac Life Support KW - virtual reality KW - serious game KW - randomized controlled trial KW - Advanced Life Support N2 - Background: Simulation-based Advanced Cardiac Life Support (ACLS) or Advanced Life Support (ALS) training for health care professionals is important worldwide for saving lives. Virtual reality (VR)?based serious gaming can be an alternative modality to be used as a part of simulation-based ALS training. Objective: The aim of this study is to investigate whether a VR-based ALS serious game module can replace classroom-based ALS lectures, the latter being part of existing conventional ALS training protocols in addition to skills training. Methods: Participants were students from Acibadem Mehmet Ali Aydinlar University?s Vocational School for Anesthesiology (N=29) randomly divided into 2 groups with 15 (conventional training group) and 14 (VR-based training group) participants each. Participants in the conventional training group had to complete the pretest consisting of multiple-choice questions at the beginning of the study. Afterward, they took part in an interactive classroom-based ALS lecture. The next step involved skills training with task trainers to teach them compression skills. Following this, the conventional training group was divided into Code Blue teams, each consisting of 5 participants for the simulation session. Two independent instructors evaluated video recordings in terms of technical and nontechnical skills. The score acquired from the manikin-based simulation session was considered the main performance indicator in this study to measure the learning outcome. A similar workflow was used for the VR-based training group, but this group was trained with the VR-based ALS serious game module instead of the theoretical lecture. The final stage of the study involved completing the posttest consisting of multiple-choice questions. A preference survey was conducted among the study participants. Mann-Whitney U and Wilcoxon signed-rank tests were used to analyze the 2 groups? performances in this study. Results: The improvement in posttest results compared with pretest results was significant in the conventional training group (P=.002). Hands-on technical scores of the conventional training group were higher than those of the VR-based training group during manikin-based simulation, but total scores, including those for technical and crisis resource management skills, acquired from the manikin-based simulation session did not reveal any significant difference between the 2 groups. The results of the VR preference survey revealed that the majority of the participants prefer VR-based serious game?based training instead of classroom lectures. Conclusions: Although hands-on technical scores of the conventional training group during the manikin-based simulation session were higher than those of the VR-based training group, both groups? total performance scores, including those for technical and crisis resource management skills, did not differ significantly. The preference survey reveals that the majority of the participants would prefer a VR-based ALS serious gaming module instead of lecture-based training. Further studies are required to reveal the learning outcome of VR-based ALS serious gaming. Trial Registration: ClinicalTrials.gov NCT05798910; https://clinicaltrials.gov/study/NCT05798910 UR - https://games.jmir.org/2023/1/e46964 UR - http://dx.doi.org/10.2196/46964 UR - http://www.ncbi.nlm.nih.gov/pubmed/37768719 ID - info:doi/10.2196/46964 ER - TY - JOUR AU - Dalavaye, Nishaanth AU - Baskaran, Ravanth AU - Mukhopadhyay, Srinjay AU - Gamage, Peramuna Movin AU - Ng, Vincent AU - Sharif, Hama AU - Rutherford, Stephen PY - 2023/8/17 TI - Exploring the Educational Value of Popular Culture in Web-Based Medical Education: Pre-Post Study on Teaching Jaundice Using ?The Simpsons? JO - JMIR Med Educ SP - e44789 VL - 9 KW - educational innovation KW - jaundice KW - medical education KW - popular culture KW - web-based teaching N2 - Background: The potential of popular culture as a tool for knowledge delivery and enhancing engagement in education is promising but not extensively studied. Furthermore, concerns exist regarding learning fatigue due to increased reliance on videoconferencing platforms following the COVID-19 pandemic. To ensure effective web-based teaching sessions that maintain attention spans and enhance understanding, innovative solutions are necessary. Objective: This study aims to evaluate the use of specific popular culture case studies to enhance student engagement in a web-based near-peer teaching session. Methods: We delivered a web-based teaching session to undergraduate medical students in the United Kingdom. The session included clinical vignettes and single-best-answer questions using characters from ?The Simpsons? television show as patient analogies for various causes of jaundice. A pre-post survey, employing a 7-point Likert scale, was distributed to gather data from participants. Results: A total of 53 survey responses were collected. Participants reported significantly improved understanding of jaundice after the session compared to before the session (median 6, IQR 5-6 vs median 4, IQR 3-4.5; P<.001). The majority of participants agreed that the inclusion of ?The Simpsons? characters enhanced their knowledge and made the teaching session more memorable and engaging (memorability: median 6, IQR 5-7; engagement: median 6, IQR 5-7). Conclusions: When appropriately integrated, popular culture can effectively engage students and improve self-perceived knowledge retention. ?The Simpsons? characters can be used pedagogically and professionally as patient analogies to deliver teaching on the topic of jaundice. UR - https://mededu.jmir.org/2023/1/e44789 UR - http://dx.doi.org/10.2196/44789 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590059 ID - info:doi/10.2196/44789 ER - TY - JOUR AU - Stanich, Jessica AU - Sunga, Kharmene AU - Loprinzi-Brauer, Caitlin AU - Ginsburg, Alexander AU - Ingram, Cory AU - Bellolio, Fernanda AU - Cabrera, Daniel PY - 2023/8/16 TI - Teaching Palliative Care to Emergency Medicine Residents Using Gamified Deliberate Practice-Based Simulation: Palliative Gaming Simulation Study JO - JMIR Med Educ SP - e43710 VL - 9 KW - palliative care KW - emergency medicine KW - gaming simulation KW - resident education KW - medical education KW - residency KW - end of life KW - palliative KW - dying KW - death KW - interpersonal skill N2 - Background: Emergency departments (EDs) care for many patients nearing the end of life with advanced serious illnesses. Simulation training offers an opportunity to teach physicians the interpersonal skills required to manage end-of-life care. Objective: We hypothesized a gaming simulation of an imminently dying patient using the LIVE. DIE. REPEAT (LDR) format, would be perceived as an effective method to teach end-of-life communication and palliative care management skills. Methods: This was a gaming simulation replicating the experience of caring for a dying patient with advanced serious illness in the ED. The scenario involved a patient with pancreatic cancer presenting with sepsis and respiratory distress, with a previously established goal of comfort care. The gaming simulation game was divided into 4 stages, and at each level, learners were tasked with completing 1 critical action. The gaming simulation was designed using the LDR serious game scheme in which learners are allowed infinite opportunities to progress through defined stages depicting a single patient scenario. If learners successfully complete the predetermined critical actions of each stage, the game is paused, and there is a debriefing to reinforce knowledge or skills before progressing to the next stage of the gaming simulation. Conversely, if learners do not achieve the critical actions, the game is over, and learners undergo debriefing before repeating the failed stage with an immediate transition into the next. We used the Simulation Effectiveness Tool?Modified survey to evaluate perceived effectiveness in teaching end-of-life management. Results: Eighty percent (16/20) of residents completed the Simulation Effectiveness Tool?Modified survey, and nearly 100% (20/20) either strongly or somewhat agreed that the gaming simulation improved their skills and confidence at the end of life in the following dimensions: (1) better prepared to respond to changes in condition, (2) more confident in assessment skills, (3) teaching patients, (4) reporting to the health care team, (5) empowered to make clinical decisions, and (6) able to prioritize care and interventions. All residents felt the debriefing contributed to learning and provided opportunities to self-reflect. All strongly or somewhat agree that they felt better prepared to respond to changes in the patient?s condition, had a better understanding of pathophysiology, were more confident on their assessment skills, and had a better understanding of the medications and therapies after the gaming simulation. A total of 88% (14/16) of them feel more empowered to make clinical decisions. After completing the gaming simulation, 88% (14/16) of residents strongly agreed that they would feel more confident communicating with a patient and prioritizing care interventions in this context. Conclusions: This palliative gaming simulation using the LDR format was perceived by resident physicians to improve confidence in end-of-life communication and palliative care management. UR - https://mededu.jmir.org/2023/1/e43710 UR - http://dx.doi.org/10.2196/43710 UR - http://www.ncbi.nlm.nih.gov/pubmed/37585258 ID - info:doi/10.2196/43710 ER - TY - JOUR AU - Deutsch, E. Judith AU - Palmieri, L. John AU - Gorin, Holly AU - Wendell, Augustus AU - Wohn, Yvette Donghee AU - Damodaran, Harish PY - 2023/8/10 TI - Student and Faculty Perspectives on the Usefulness and Usability of a Digital Health Educational Tool to Teach Standardized Assessment of Persons After Stroke: Mixed Methods Study JO - JMIR Med Educ SP - e44361 VL - 9 KW - physical therapy KW - education KW - teaching tool KW - simulation-based learning KW - computer-aided instruction KW - standardized assessment KW - clinical reasoning KW - sensors N2 - Background: The VSTEP Examination Suite is a collection of evidence-based standardized assessments for persons after stroke. It was developed by an interdisciplinary team in collaboration with clinician users. It consists of 5 standardized assessments: 2 performance-based tests using the Kinect camera (Microsoft Corp) to collect kinematics (5-Time Sit-to-Stand and 4-Square Test); 2 additional performance-based tests (10-Meter Walk Test and 6-Minute Walk Test); and 1 patient-reported outcome measure, the Activities-Specific Balance Confidence Scale. Objective: This study aimed to describe the development of the VSTEP Examination Suite and its evaluation as an educational tool by physical therapy students and faculty to determine its usefulness and usability. Methods: A total of 6 students from a Doctor of Physical Therapy program in the United States and 6 faculty members who teach standardized assessments in different physical therapy programs from the United States and Israel were recruited by convenience sampling to participate in the study. They interacted with the system using a talk-aloud procedure either in pairs or individually. The transcripts of the sessions were coded deductively (by 3 investigators) with a priori categories of usability and usefulness, and comments were labeled as negative or positive. The frequencies of the deductive themes of usefulness and usability were tested for differences between faculty and students using a Wilcoxon rank sum test. A second round of inductive coding was performed by 3 investigators guided by theories of technology adoption, clinical reasoning, and education. Results: The faculty members? and students? positive useful comments ranged from 83% (10/12) to 100%. There were no significant differences in usefulness comments between students and faculty. Regarding usability, faculty and students had the lowest frequency of positive comments for the 10-Meter Walk Test (5/10, 50%). Students also reported a high frequency of negative comments on the 4-Square Test (9/21, 43%). Students had a statistically significantly higher number of negative usability comments compared with faculty (W=5.7; P=.02), specifically for the 5-Time Sit-to-Stand (W=5.3; P=.02). Themes emerged related to variable knowledge about the standardized tests, value as a teaching and learning tool, technology being consistent with clinical reasoning in addition to ensuring reliability, expert-to-novice clinical reasoning (students), and usability. Conclusions: The VSTEP Examination Suite was found to be useful by both faculty and students. Reasons for perceived usefulness had some overlap, but there were also differences based on role and experience. Usability testing revealed opportunities for technology refinement. The development of the technology by interdisciplinary teams and testing with multiple types of users may increase adoption. UR - https://mededu.jmir.org/2023/1/e44361 UR - http://dx.doi.org/10.2196/44361 UR - http://www.ncbi.nlm.nih.gov/pubmed/37561552 ID - info:doi/10.2196/44361 ER - TY - JOUR AU - Gisondi, Albert Michael AU - Keyes, Timothy AU - Zucker, Shana AU - Bumgardner, Deila PY - 2023/7/21 TI - Teaching LGBTQ+ Health, a Web-Based Faculty Development Course: Program Evaluation Study Using the RE-AIM Framework JO - JMIR Med Educ SP - e47777 VL - 9 KW - lesbian, gay, bisexual, transgender, queer KW - LGBTQ+ KW - queer KW - faculty development KW - medical education KW - continuing education KW - sexual and gender minority KW - web-based learning KW - asynchronous learning KW - education technology KW - diversity, equity, inclusion KW - DEI N2 - Background: Many health professions faculty members lack training on fundamental lesbian, gay, bisexual, transgender, and queer (LGBTQ+) health topics. Faculty development is needed to address knowledge gaps, improve teaching, and prepare students to competently care for the growing LGBTQ+ population. Objective: We conducted a program evaluation of the massive open online course Teaching LGBTQ+ Health: A Faculty Development Course for Health Professions Educators from the Stanford School of Medicine. Our goal was to understand participant demographics, impact, and ongoing maintenance needs to inform decisions about updating the course. Methods: We evaluated the course for the period from March 27, 2021, to February 24, 2023, guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. We assessed impact using participation numbers, evidence of learning, and likelihood of practice change. Data included participant demographics, performance on a pre- and postcourse quiz, open-text entries throughout the course, continuing medical education (CME) credits awarded, and CME course evaluations. We analyzed demographics using descriptive statistics and pre- and postcourse quiz scores using a paired 2-tailed t test. We conducted a qualitative thematic analysis of open-text responses to prompts within the course and CME evaluation questions. Results: Results were reported using the 5 framework domains. Regarding Reach, 1782 learners participated in the course, and 1516 (85.07%) accessed it through a main course website. Of the different types of participants, most were physicians (423/1516, 27.9%) and from outside the sponsoring institution and target audience (1452/1516, 95.78%). Regarding Effectiveness, the median change in test scores for the 38.1% (679/1782) of participants who completed both the pre- and postcourse tests was 3 out of 10 points, or a 30% improvement (P<.001). Themes identified from CME evaluations included LGBTQ+ health as a distinct domain, inclusivity in practices, and teaching LGBTQ+ health strategies. A minority of participants (237/1782, 13.3%) earned CME credits. Regarding Adoption, themes identified among responses to prompts in the course included LGBTQ+ health concepts and instructional strategies. Most participants strongly agreed with numerous positive statements about the course content, presentation, and likelihood of practice change. Regarding Implementation, the course cost US $57,000 to build and was intramurally funded through grants and subsidies. The course faculty spent an estimated 600 hours on the project, and educational technologists spent another 712 hours. Regarding Maintenance, much of the course is evergreen, and ongoing oversight and quality assurance require minimal faculty time. New content will likely include modules on transgender health and gender-affirming care. Conclusions: Teaching LGBTQ+ Health improved participants? knowledge of fundamental queer health topics. Overall participation has been modest to date. Most participants indicated an intention to change clinical or teaching practices. Maintenance costs are minimal. The web-based course will continue to be offered, and new content will likely be added. UR - https://mededu.jmir.org/2023/1/e47777 UR - http://dx.doi.org/10.2196/47777 UR - http://www.ncbi.nlm.nih.gov/pubmed/37477962 ID - info:doi/10.2196/47777 ER - TY - JOUR AU - Kumwichar, Ponlagrit PY - 2023/5/29 TI - Enhancing Learning About Epidemiological Data Analysis Using R for Graduate Students in Medical Fields With Jupyter Notebook: Classroom Action Research JO - JMIR Med Educ SP - e47394 VL - 9 KW - learning KW - Jupyter KW - R KW - epidemiology KW - data analysis KW - medical education KW - graduate student KW - longitudinal data analysis KW - graduate education KW - implementation N2 - Background: Graduate students in medical fields must learn about epidemiology and data analysis to conduct their research. R is a software environment used to develop and run packages for statistical analysis; it can be challenging for students to learn because of compatibility with their computers and problems with package installations. Jupyter Notebook was used to run R, which enhanced the graduate students? ability to learn epidemiological data analysis by providing an interactive and collaborative environment that allows for more efficient and effective learning. Objective: This study collected class reflections from students and their lecturer in the class ?Longitudinal Data Analysis Using R,? identified problems that occurred, and illustrated how Jupyter Notebook can solve those problems. Methods: The researcher analyzed issues encountered in the previous class and devised solutions using Jupyter Notebook. These solutions were then implemented and applied to a new group of students. Reflections from the students were regularly collected and documented in an electronic form. The comments were then thematically analyzed and compared to those of the prior cohort. Results: Improvements that were identified included the ease of using Jupyter R for data analysis without needing to install packages, increased student questioning due to curiosity, and students having the ability to immediately use all code functions. After using Jupyter Notebook, the lecturer could stimulate interest more effectively and challenge students. Furthermore, they highlighted that students responded to questions. The student feedback shows that learning R with Jupyter Notebook was effective in stimulating their interest. Based on the feedback received, it can be inferred that using Jupyter Notebook to learn R is an effective approach for equipping students with an all-encompassing comprehension of longitudinal data analysis. Conclusions: The use of Jupyter Notebook can improve graduate students? learning experience for epidemiological data analysis by providing an interactive and collaborative environment that is not affected by compatibility issues with different operating systems and computers. UR - https://mededu.jmir.org/2023/1/e47394 UR - http://dx.doi.org/10.2196/47394 UR - http://www.ncbi.nlm.nih.gov/pubmed/37247206 ID - info:doi/10.2196/47394 ER - TY - JOUR AU - Haupt, Franziska AU - Kanzow, Philipp PY - 2023/4/18 TI - The Relation Between Students? Theoretical Knowledge and Practical Skills in Endodontics: Retrospective Analysis JO - Interact J Med Res SP - e46305 VL - 12 KW - curricula KW - curriculum KW - dental KW - dental education KW - dentist KW - dentistry KW - endodontics KW - endodontology KW - educational assessment KW - educational measurement KW - examination KW - knowledge assessment KW - practical skills KW - skill assessment KW - theoretical knowledge KW - undergraduate KW - undergraduate curriculum KW - undergraduate education N2 - Background: Dental undergraduate students are required to show sufficient practical skills prior to treating patients. Practical skills and the underlying theoretical knowledge are taught in preclinical courses. Usually, the learning outcome is assessed in written multiple-choice examinations (theoretical knowledge) and practical skills tests. However, students? assessment of practical skills is more time consuming and prone to bias than objective multiple-choice examinations. Objective: This study aims to analyze the relation between students? theoretical knowledge and practical skills in endodontics. Furthermore, the predictive validity of a theoretical knowledge assessment on students? practical skills was assessed. Methods: Examination results from all students who participated in the preclinical phantom course in Operative Dentistry (sixth semester of the undergraduate dental curriculum in Germany) between the 2015 summer term and the 2022 summer term were retrospectively evaluated (N=447). The effects of age, sex, previous course participation, and theoretical knowledge on students? practical skills were assessed, using Pearson correlations, Wilcoxon rank sum tests, and a linear regression analysis. Subsequently, students? theoretical knowledge and practical skills were compared via a Fisher exact test to identify a suitable pass mark for students? theoretical knowledge that was associated with sufficient practical skills (?60%). Results: Students? theoretical knowledge was significantly associated with practical skills (Padjusted=.02; r=0.13). By using the current pass mark for theoretical knowledge (ie, 60%), a significant differentiation between insufficient practical skills (<60%) and sufficient practical skills (?60%) was achieved (P=.02). However, for the discrimination between students with sufficient practical skills and students with insufficient practical skills, an adapted pass mark for theoretical knowledge would be more appropriate. The ideal pass mark amounted to 58% (P=.02). Conclusions: Students? practical skills and theoretical knowledge are significantly correlated. By objectively measuring students? theoretical knowledge, a rough estimation of students? practical skills (ie, a differentiation between sufficient and insufficient practical skills) is possible. UR - https://www.i-jmr.org/2023/1/e46305 UR - http://dx.doi.org/10.2196/46305 UR - http://www.ncbi.nlm.nih.gov/pubmed/36994987 ID - info:doi/10.2196/46305 ER - TY - JOUR AU - Cheng, Lucille AU - Senathirajah, Yalini PY - 2023/4/13 TI - Using Clinical Data Visualizations in Electronic Health Record User Interfaces to Enhance Medical Student Diagnostic Reasoning: Randomized Experiment JO - JMIR Hum Factors SP - e38941 VL - 10 KW - electronic health record KW - EHR KW - System-1?type diagnostic reasoning KW - type-1 reasoning KW - diagnostic KW - diagnosis KW - user interface KW - user design KW - heuristics KW - medical education KW - clinical reasoning KW - reasoning process KW - data visualization KW - hGraph KW - cognitive burden KW - cognitive load KW - medical student KW - medical school N2 - Background: In medicine, the clinical decision-making process can be described using the dual-process theory consisting of the fast, intuitive ?System 1,? commonly seen in seasoned physicians, and the slow, deliberative ?System 2,? associated with medical students. System-1?type diagnostic reasoning is thought to be less cognitively burdensome, thereby reducing physician error. To date, limited literature exists on inducing System-1?type diagnosis in medical students through cognitive heuristics, particularly while using modern electronic health record (EHR) interfaces. Objective: In this experimental pilot study, we aimed to (1) attempt to induce System-1?type diagnostic reasoning in inexperienced medical students through the acquisition of cognitive user interface heuristics and (2) understand the impact of clinical patient data visualizations on students' cognitive load and medical education. Methods: The participants were third- and fourth-year medical students recruited from the University of Pittsburgh School of Medicine who had completed 1+ clinical rotations. The students were presented 8 patient cases on a novel EHR, featuring a prominent data visualization designed to foster at-a-glance rapid case assessment, and asked to diagnose the patient. Half of the participants were shown 4 of the 8 cases repeatedly, up to 4 times with 30 seconds per case (Group A), and the other half of the participants were shown cases twice with 2 minutes per case (Group B). All participants were then asked to provide full diagnoses of all 8 cases. Finally, the participants were asked to evaluate and elaborate on their experience with the system; content analysis was subsequently performed on these user experience interviews. Results: A total of 15 students participated. The participants in Group A scored slightly higher on average than those in Group B, with a mean percentage correct of 76% (95% CI 0.68-0.84) versus 69% (95% CI 0.58-0.80), and spent on average 50% less time per question than Group B diagnosing patients (13.98 seconds vs 19.13 seconds, P=.03, respectively). When comparing the novel EHR design to previously used EHRs, 73% (n=11) of participants rated the new version on par or higher (3+/5). Ease of use and intuitiveness of this new system rated similarly high (mean score 3.73/5 and 4.2/5, respectively). In qualitative thematic analysis of poststudy interviews, most participants (n=11, 73%) spoke to ?pattern-recognition? cognitive heuristic strategies consistent with System 1 decision-making. Conclusions: These results support the possibility of inducing type-1 diagnostics in learners and the potential for data visualization and user design heuristics to reduce cognitive burden in clinical settings. Clinical data presentation in the diagnostic reasoning process is ripe for innovation, and further research is needed to explore the benefit of using such visualizations in medical education. UR - https://humanfactors.jmir.org/2023/1/e38941 UR - http://dx.doi.org/10.2196/38941 UR - http://www.ncbi.nlm.nih.gov/pubmed/37053000 ID - info:doi/10.2196/38941 ER - TY - JOUR AU - Otaki, Farah AU - Gholami, Mandana AU - Fawad, Iman AU - Akbar, Anjum AU - Banerjee, Yajnavalka PY - 2023/3/20 TI - Students? Perception of Formative Assessment as an Instructional Tool in Competency-Based Medical Education: Proposal for a Proof-of-Concept Study JO - JMIR Res Protoc SP - e41626 VL - 12 KW - medical education KW - formative assessment KW - summative assessment KW - student KW - education KW - competency-based KW - proof-of-concept KW - perception KW - biochemistry KW - curriculum KW - teacher KW - educator KW - medical school KW - skill assessment KW - knowledge assessment KW - knowledge evaluation N2 - Background: In competency-based medical education (CBME), ?Assessment for learning? or ?Formative Assessment? (FA) plays a key role in augmenting student learning. FAs help students to measure their progress over time, enabling them to proactively improve their performance in summative assessments. FAs also encourage students to learn in a way where they address their knowledge gaps and gaps in their conceptualization of the subject matter. The effectiveness of an FA, as a learning and development instrument, relies on the degree of student involvement in the corresponding educational intervention?s design and implementation. The extent of students? engagement in FA can be evaluated by appraising their perception regarding the educational intervention itself. Objective: This proof-of-concept study aims to develop a systemic understanding of a Formative Assessment as an Instructional Tool (FAIS) implemented in a biochemistry course in the Basic Medical Sciences component of an undergraduate entry, CBME. Methods: The educational intervention in question is an FAIS, which is implemented in a biochemistry course in the first semester of a 6-year bachelor of medicine, bachelor of surgery program. When developing the FAIS, each area of knowledge, skills, and attitudes were considered. Assessment formats are developed per Miller?s learning pyramid. This multiphase study is meant to rely on a convergent mixed methods design, where qualitative and quantitative data are independently collected and analyzed. Thereafter, the outputs of analyses are systematically merged using joint display analysis process. Qualitative data are collected through a focus group session that captures the students? perception toward the FAIS. Data collection, integral to this focus group session, is exploratory. The inductive qualitative data analysis follows Braun and Clarke?s 6-step framework. The quantitative component of this study revolves around investigating the effect of the FAIS on the course?s summative assessment. The summative assessment performance of the 71 students, enrolled in the FAIS cohort, will be compared to that of the students in the non-FAIS cohort. The total duration of the proposed multiphase research study is 6 months. Results: This proposed multiphase study is expected to showcase, from a systemic perspective, the effectiveness of the respective educational intervention. It will shed light on the participating students? attitudes in relation to the usefulness of FA in achieving competency goals and in fostering self-directed learning. The proposed study could also uncover the hypothesized association between the FA intervention and enhanced performance in summative assessments. Conclusions: Our findings will generate evidence regarding the application of FAs, which can be leveraged by other medical educators in contexts similar to those under investigation. International Registered Report Identifier (IRRID): DERR1-10.2196/41626 UR - https://www.researchprotocols.org/2023/1/e41626 UR - http://dx.doi.org/10.2196/41626 UR - http://www.ncbi.nlm.nih.gov/pubmed/36939831 ID - info:doi/10.2196/41626 ER - TY - JOUR AU - Bhatti, Faheem AU - Mowforth, Oliver AU - Butler, Max AU - Bhatti, Zainab AU - Rafati Fard, Amir AU - Kuhn, Isla AU - Davies, M. Benjamin PY - 2023/3/15 TI - Meeting the Shared Goals of a Student-Selected Component: Pilot Evaluation of a Collaborative Systematic Review JO - JMIR Med Educ SP - e39210 VL - 9 KW - medical education KW - medical student KW - research training KW - research methodology KW - systematic review KW - methodology KW - review KW - collaboration KW - collaborative KW - medical school KW - medical librarian KW - library science KW - information science KW - search strategy KW - student-selected component KW - curriculum KW - curricula N2 - Background: Research methodology is insufficiently featured in undergraduate medical curricula. Student-selected components are designed to offer some research opportunities but frequently fail to meet student or supervisor expectations, such as completion or publication. We hypothesized that a collaborative, educational approach to a systematic review (SR), whereby medical students worked together, may improve student experience and increase success. Objective: This study aimed to establish whether offering a small team of students the opportunity to take part in the screening phase of SRs led by an experienced postgraduate team could enhance the learning experience of students, overcome the barriers to successful research engagement, and deliver published output. Methods: Postgraduate researchers from the University of Cambridge led a team of 14 medical students to work on 2 neurosurgical SRs. One student was appointed as the lead for each SR. All students were provided with training on SR methodology and participated in title and abstract screening using Rayyan software. Students completed prepilot, midscreening, and postscreening questionnaires on their research background, perceptions, knowledge, confidence, and experience. Questions were scored on a Likert scale of 1 (strongly disagree) to 10 (strongly agree). Results: Of the 14 students involved, 29% (n=4) reported that they had received sufficient training in research methodology at medical school. Positive trends in student knowledge, confidence, and experience of SR methodology were noted across the 3 questionnaire time points. Mean responses to ?I am satisfied with the level of guidance I am receiving,? ?I am enjoying being involved in the SR process,? and ?I could not gain this understanding of research from passive learning e.g., textbook or lecture? were greater than 8.0 at all time points. Students reported ?being involved in this research has made me more likely to do research in the future? (mean 8.57, SD 1.50) and that ?this collaborative SR improved my research experience? (mean 8.50, SD 1.56). Conclusions: This collaborative approach appears to be a potentially useful method of providing students with research experience; however, it requires further evaluation. UR - https://mededu.jmir.org/2023/1/e39210 UR - http://dx.doi.org/10.2196/39210 UR - http://www.ncbi.nlm.nih.gov/pubmed/36920459 ID - info:doi/10.2196/39210 ER - TY - JOUR AU - Mahling, Moritz AU - Wunderlich, Robert AU - Steiner, Daniel AU - Gorgati, Eleonora AU - Festl-Wietek, Teresa AU - Herrmann-Werner, Anne PY - 2023/3/3 TI - Virtual Reality for Emergency Medicine Training in Medical School: Prospective, Large-Cohort Implementation Study JO - J Med Internet Res SP - e43649 VL - 25 KW - emergency medicine KW - resuscitation KW - virtual reality KW - simulation KW - undergraduate medical education KW - Germany KW - medical education KW - virtual training KW - digital learning KW - medical student N2 - Background: Virtual reality (VR)?based simulation is being increasingly used to train medical students in emergency medicine. However, because the usefulness of VR may depend on various factors, the best practices for implementing this technology in the medical school curriculum are yet to be determined. Objective: The overall objective of our study was to assess the perceptions of a large cohort of students toward VR-based training and to identify the associations between these attitudes and individual factors, such as gender and age. Methods: The authors implemented a voluntary, VR-based teaching session in the emergency medicine course at the Medical Faculty in Tübingen, Germany. Fourth-year medical students were invited to participate on a voluntary basis. Afterward, we asked the students about their perceptions, collected data on individual factors, and assessed the test scores achieved by them in the VR-based assessment scenarios. We used ordinal regression analysis and linear mixed-effects analysis to detect the impact of individual factors on the questionnaire answers. Results: A total of 129 students participated in our study (mean age 24.7, SD 2.9 years; n=51, 39.8% male; n=77, 60.2% female). No student had previously used VR for learning, and only 4.7% (n=6) of the students had prior experience with VR. Most of the students agreed that VR can convey complex issues quickly (n=117, 91%), that VR is a useful addition to mannequin-based courses (n=114, 88%) or could even replace them (n=93, 72%), and that VR simulations should also be used for examinations (n=103, 80%). However, female students showed significantly less agreement with these statements. Most students perceived the VR scenario as realistic (n=69, 53%) and intuitive (n=62, 48%), with a relatively lower agreement for the latter among female respondents. We found high agreement among all participants (n=88, 69%) for immersion but strong disagreement (n=69, 54%) for empathy with the virtual patient. Only 3% (n=4) of the students felt confident regarding the medical content. Responses for the linguistic aspects of the scenario were largely mixed; however, most of the students were confident with the English language (not native) scenarios and disagreed that the scenario should be offered in their native language (female students agreed more strongly than male students). Most of the students would not have felt confident with the scenarios in a real-world context (n=69, 53%). Although physical symptoms during VR sessions were reported by 16% (n=21) of the respondents, this did not lead to the termination of the simulation. The regression analysis revealed that the final test scores were not influenced by gender, age, or prior experience in emergency medicine or with virtual reality. Conclusions: In this study, we observed a strong positive attitude in medical students toward VR-based teaching and assessment. However, this positivity was comparatively lower among female students, potentially indicating that gender differences need to be addressed when VR is implemented in the curriculum. Interestingly, gender, age, or prior experience did not influence the final test scores. Furthermore, confidence regarding the medical content was low, which suggests that the students may need further training in emergency medicine. UR - https://www.jmir.org/2023/1/e43649 UR - http://dx.doi.org/10.2196/43649 UR - http://www.ncbi.nlm.nih.gov/pubmed/36867440 ID - info:doi/10.2196/43649 ER - TY - JOUR AU - Perrin, Julien AU - Meeus, Amélie AU - Broseus, Julien AU - Morieux, Pierre-Jean AU - Di Ceglie, Valentine AU - Gravoulet, Julien AU - D'Aveni, Maud PY - 2023/2/13 TI - A Serious Game About Hematology for Health Care Workers (SUPER HEMO): Development and Validation Study JO - JMIR Serious Games SP - e40350 VL - 11 KW - educational technology KW - hematology KW - health care students KW - education KW - teaching KW - validation KW - methodological study KW - video support tool KW - continuing education KW - serious games KW - educational games N2 - Background: Complete blood count (CBC) and hemostatic screening tests are among the most commonly prescribed blood tests worldwide. All health care workers (nurse practitioners, pharmacists, dentists, midwives, and physicians) are expected to correctly interpret the results in their daily practice. Currently, the undergraduate hematology curriculum consists predominantly of lecture-based teaching. Because hematology combines basic science (blood cells and hemostasis physiology) and clinical skills, students report that they do not easily master hematology with only lecture-based teaching. Having interviewed students at the University of Lorraine, we considered it necessary to develop new teaching approaches and methods. Objective: We aimed to develop and validate a serious game about CBC analysis for health care students. Our primary objective was to help students perceive hematology as being a playful and easy topic and for them to feel truly involved in taking care of their patients by analyzing blood tests. We considered that this game-based approach would be attractive to students as an addition to the classic lecture-based approach and improve their knowledge and skills in hematology. Methods: We developed an adventure game called SUPER HEMO, a video game in which the player assumes the role of a protagonist in an interactive story driven by exploration and problem-solving tests. Following validation with beta testing by a panel of volunteer students, we used a novel, integrated teaching approach. We added 1.5 hours of gaming to the standard curriculum for a small group of volunteer students. Physician and pharmacy students in their third year at a single French university were invited to attend this extracurricular course. Pregame and postgame tests and satisfaction surveys were immediately recorded. Final hematology exam results were analyzed. Results: A total of 86 of 324 physician students (26.5%) and 67 of 115 pharmacy students (58%) opted to participate. Median scores on the pre- and posttests were 6 out of 10 versus 7 out of 10, respectively, for the physician students, (P<.001) and 7.5 out of 10 versus 8 out of 10, respectively, for the pharmacy students (P<.001). At the final hematology evaluation, physician students who played SUPER HEMO had a slightly better median score than those who did not: 13 out of 20 versus 12 out of 20, respectively (P=.002). Pharmacy students who played SUPER HEMO had a median score of 21.75 out of 30; this was not significantly different from pharmacy students who did not play SUPER HEMO (20/30; P=.12). Among the participants who answered the survey (n=143), more than 86% (123/143) believed they had strengthened their knowledge and nearly 80% (114/143) of them had fun. Conclusions: Feedback from this game session provided evidence to support the integration of interactive teaching methods in undergraduate hematology teaching. The development of SUPER HEMO is intended to be completed so that it can become a support tool for continuing education. UR - https://games.jmir.org/2023/1/e40350 UR - http://dx.doi.org/10.2196/40350 UR - http://www.ncbi.nlm.nih.gov/pubmed/36780215 ID - info:doi/10.2196/40350 ER - TY - JOUR AU - Tran, Carrie AU - Toth-Pal, Eva AU - Ekblad, Solvig AU - Fors, Uno AU - Salminen, Helena PY - 2023/1/17 TI - Medical Students? Learning About Other Professions Using an Interprofessional Virtual Patient While Remotely Connected With a Study Group: Mixed Methods Study JO - JMIR Med Educ SP - e38599 VL - 9 KW - interprofessional learning KW - virtual patient KW - medical students KW - remote learning KW - distance learning KW - medical education N2 - Background: Collaboration with other professions is essential in health care education to prepare students for future clinical teamwork. However, health care education still struggles to incorporate interprofessional education. Distance learning and virtual patients (VPs) may be useful additional methods to increase students? possibilities for interprofessional learning. Objective: This study had two aims. The first was to assess if an interprofessional VP case could facilitate medical students? learning about team collaboration in online groups. The second was to assess how students experienced learning with the VP when remotely connected with their group. Methods: A mixed methods design was used. The VP case was a 73-year-old man who needed help from different health professions in his home after a hip fracture. Questionnaires were answered by the students before and directly after each session. Qualitative group interviews were performed with each group of students directly after the VP sessions, and the interviews were analyzed using qualitative content analysis. Results: A total of 49 third-year medical students divided into 15 groups participated in the study. Each group had 2 to 5 students who worked together with the interprofessional VP without a teacher?s guidance. In the analysis of the group interviews, a single theme was identified: the interprofessional VP promoted student interaction and gave insight into team collaboration. Two categories were found: (1) the structure of the VP facilitated students? learning and (2) students perceived the collaboration in their remotely connected groups as functioning well and being effective. The results from the questionnaires showed that the students had gained insights into the roles and competencies of other health care professions. Conclusions: This study demonstrates that an interprofessional VP enabled insights into team collaboration and increased understanding of other professions among student groups comprising only medical students. The interprofessional VP seemed to benefit students? learning in an online, remote-learning context. Although our VP was not used as an interprofessional student activity according to the common definition of interprofessional education, the results imply that it still contributed to students? interprofessional learning. UR - https://mededu.jmir.org/2023/1/e38599 UR - http://dx.doi.org/10.2196/38599 UR - http://www.ncbi.nlm.nih.gov/pubmed/36649071 ID - info:doi/10.2196/38599 ER - TY - JOUR AU - Newcomer, Valerie AU - Metzinger, Megan AU - Vick, Sydney AU - Robertson, Caroline AU - Lawrence, Taylor AU - Glass, Amanda AU - Elliott, Lauren AU - Williams, Ansleigh PY - 2022/9/30 TI - A Stroke Rehabilitation Educational Program for Occupational Therapy Students and Practitioners: Usability Study JO - JMIR Med Educ SP - e35637 VL - 8 IS - 3 KW - knowledge translation KW - task-oriented training KW - stroke assessments KW - telerehabilitation KW - occupational therapy KW - students KW - practitioners KW - educational program N2 - Background: There are gaps in knowledge translation (KT) of current evidence-based practices regarding stroke assessment and rehabilitation delivered through teletherapy. A lack of this knowledge can prevent occupational therapy (OT) students and practitioners from implementing current research findings. Objective: The aim of this pilot study was to create an educational program to translate knowledge into practice regarding the remote delivery of stroke assessment and rehabilitation to OT students and practitioners. Four areas of focus were addressed in the educational program, including KT, task-oriented training, stroke assessments, and telerehabilitation. Methods: Two pilot studies were conducted to assess the knowledge gained via pretests and posttests of knowledge, followed by a System Usability Scale and general feedback questionnaire. Participants in study 1 were 5 OT practitioners and 1 OT assistant. Participants in study 2 were 9 current OT students. Four 1-hour modules were emailed weekly to participants over the course of 4 weeks, with each module covering a different topic (KT, task-oriented training, stroke assessments, and telerehabilitation). Preliminary results were reviewed using descriptive statistics. Results: Statistically significant results were found with increased scores of knowledge for both students and practitioners. Most of the educational modules had an above-average score regarding value and positive feedback for the educational program as a whole from the participants. Conclusions: Overall, the results of this pilot study indicate that a web-based educational program is a valuable, informational method of increasing the translation of knowledge in the remote delivery of stroke assessment and rehabilitation. OT students and practitioners found the information presented to be valuable and relevant to their future profession and current practice. UR - https://mededu.jmir.org/2022/3/e35637 UR - http://dx.doi.org/10.2196/35637 UR - http://www.ncbi.nlm.nih.gov/pubmed/36178717 ID - info:doi/10.2196/35637 ER - TY - JOUR AU - Safari, Yahya AU - Yousefpoor, Nasrin PY - 2022/7/28 TI - The Role of Metacognitive Beliefs in Predicting Academic Procrastination Among Students in Iran: Cross-sectional Study JO - JMIR Med Educ SP - e32185 VL - 8 IS - 3 KW - procrastination KW - metacognitive awareness KW - medical students KW - academic training N2 - Background: Academic procrastination is a challenge that many students face. Metacognitive beliefs are the main cause of academic procrastination because they are one of the main reasons for students' academic failure or progress. Objective: This study aimed to determine whether and to what extent academic procrastination could be predicted based on students? metacognitive beliefs. Methods: This descriptive cross-sectional study involved 300 students selected via stratified random sampling. Data were collected using the Procrastination Assessment Scale for Students and the Metacognition Questionnaire-30. The data analysis was done using the Pearson correlation coefficient and regression analysis to estimate the correlation coefficient and predictability of academic procrastination based on metacognitive beliefs. Results: A significant negative correlation was observed between the subscale of positive beliefs of concern and academic procrastination (r=?0.16; P<.001). In addition, the metacognitive beliefs of the participants predicted 10% of academic procrastination. The component of positive metacognitive beliefs with the ? value of 0.45 negatively and significantly predicted the students? academic procrastination (P<.001), whereas the component of negative metacognitive beliefs with the ? value of .39 positively and significantly predicted the students? academic procrastination (P<.001). Conclusions: Metacognitive beliefs can predict students' academic procrastination. Therefore, the modification of metacognitive beliefs to reduce procrastination is suggested. UR - https://mededu.jmir.org/2022/3/e32185 UR - http://dx.doi.org/10.2196/32185 UR - http://www.ncbi.nlm.nih.gov/pubmed/35900821 ID - info:doi/10.2196/32185 ER - TY - JOUR AU - Kiesewetter, Jan AU - Hege, Inga AU - Sailer, Michael AU - Bauer, Elisabeth AU - Schulz, Claudia AU - Platz, Manfred AU - Adler, Martin PY - 2022/7/28 TI - Implementing Remote Collaboration in a Virtual Patient Platform: Usability Study JO - JMIR Med Educ SP - e24306 VL - 8 IS - 3 KW - collaborative learning KW - clinical reasoning KW - webRTC KW - collaboration KW - collaborative KW - decision making N2 - Background: Learning with virtual patients is highly popular for fostering clinical reasoning in medical education. However, little learning with virtual patients is done collaboratively, despite the potential learning benefits of collaborative versus individual learning. Objective: This paper describes the implementation of student collaboration in a virtual patient platform. Our aim was to allow pairs of students to communicate remotely with each other during virtual patient learning sessions. We hypothesized that we could provide a collaborative tool that did not impair the usability of the system compared to individual learning and that this would lead to better diagnostic accuracy for the pairs of students. Methods: Implementing the collaboration tool had five steps: (1) searching for a suitable software library, (2) implementing the application programming interface, (3) performing technical adaptations to ensure high-quality connections for the users, (4) designing and developing the user interface, and (5) testing the usability of the tool in 270 virtual patient sessions. We compared dyad to individual diagnostic accuracy and usability with the 10-item System Usability Scale. Results: We recruited 137 students who worked on 6 virtual patients. Out of 270 virtual patient sessions per group (45 dyads times 6 virtual patients, and 47 students working individually times 6 virtual patients minus 2 randomly selected deleted sessions) the students made successful diagnoses in 143/270 sessions (53%, SD 26%) when working alone and 192/270 sessions (71%, SD 20%) when collaborating (P=.04, ?2=0.12). A usability questionnaire given to the students who used the collaboration tool showed a usability score of 82.16 (SD 1.31), representing a B+ grade. Conclusions: The collaboration tool provides a generic approach for collaboration that can be used with most virtual patient systems. The collaboration tool helped students diagnose virtual patients and had good overall usability. More broadly, the collaboration tool will provide an array of new possibilities for researchers and medical educators alike to design courses for collaborative learning with virtual patients. UR - https://mededu.jmir.org/2022/3/e24306 UR - http://dx.doi.org/10.2196/24306 UR - http://www.ncbi.nlm.nih.gov/pubmed/35900827 ID - info:doi/10.2196/24306 ER - TY - JOUR AU - Lakhtakia, Ritu AU - Otaki, Farah AU - Alsuwaidi, Laila AU - Zary, Nabil PY - 2022/7/22 TI - Assessment as Learning in Medical Education: Feasibility and Perceived Impact of Student-Generated Formative Assessments JO - JMIR Med Educ SP - e35820 VL - 8 IS - 3 KW - self-regulated learning KW - assessment as learning KW - student-generated assessments KW - lifelong learning KW - medical education N2 - Background: Self-regulated learning (SRL) is gaining widespread recognition as a vital competency that is desirable to sustain lifelong learning, especially relevant to health professions education. Contemporary educational practices emphasize this aspect of undergraduate medical education through innovative designs of teaching and learning, such as the flipped classroom and team-based learning. Assessment practices are less commonly deployed to build capacity for SRL. Assessment as learning (AaL) can be a unique way of inculcating SRL by enabling active learning habits. It charges students to create formative assessments, reinforcing student-centered in-depth learning and critical thinking. Objective: This study aimed to explore, from the learners? perspectives, the feasibility and perceived learning impact of student-generated formative assessments. Methods: This study relied on a convergent mixed methods approach. An educational intervention was deployed on a cohort of 54 students in the second year of a 6-year undergraduate medical program as part of a single-course curriculum. The AaL intervention engaged students in generating assessments using peer collaboration, tutor facilitation, and feedback. The outcomes of the intervention were measured through quantitative and qualitative data on student perceptions, which were collected through an anonymized web-based survey and in-person focus groups, respectively. Quantitative survey data were analyzed using SPSS (IBM), and qualitative inputs underwent thematic analysis. Results: The students? overall score of agreement with the AaL educational intervention was 84%, which was strongly correlated with scores for ease and impact on a 5-point Likert-type scale. The themes that emerged from the qualitative analysis included prominent characteristics, immediate gains, and expected long-term benefits of engagement. The prominent characteristics included individuals? engagement, effective interdependencies, novelty, and time requirements. The identified immediate gains highlighted increased motivation and acquisition of knowledge and skills. The expected long-term benefits included critical thinking, problem solving, and clinical reasoning. Conclusions: As a form of AaL, student-generated assessments were perceived as viable, constructive, and stimulating educational exercises by the student authors. In the short term, the activity provided students with a fun and challenging opportunity to dive deeply into the content, be creative in designing questions, and improve exam-taking skills. In the long term, students expected an enhancement of critical thinking and the inculcation of student-centered attributes of self-regulated lifelong learning and peer collaboration, which are vital to the practice of medicine. UR - https://mededu.jmir.org/2022/3/e35820 UR - http://dx.doi.org/10.2196/35820 UR - http://www.ncbi.nlm.nih.gov/pubmed/35867379 ID - info:doi/10.2196/35820 ER - TY - JOUR AU - Balapal, Neha AU - Ankem, Amala AU - Shyamsundar, Saishravan AU - He, Shuhan PY - 2022/7/18 TI - Opioid Use Disorder Education for Students and the Future of Opioid Overdose Treatment JO - JMIR Med Educ SP - e37081 VL - 8 IS - 3 KW - opioid use disorder KW - students KW - buprenorphine KW - education KW - public health KW - opioid KW - health care providers KW - healthcare providers KW - medication-assisted treatment KW - youth KW - substance use KW - opioid agonist KW - overdose UR - https://mededu.jmir.org/2022/3/e37081 UR - http://dx.doi.org/10.2196/37081 UR - http://www.ncbi.nlm.nih.gov/pubmed/35849432 ID - info:doi/10.2196/37081 ER - TY - JOUR AU - Wong, Yuen-Ha Janet AU - Ko, Joanna AU - Nam, Sujin AU - Kwok, Tyrone AU - Lam, Sheila AU - Cheuk, Jessica AU - Chan, Maggie AU - Lam, Veronica AU - Wong, C. Gordon T. AU - Ng, H. Zoe L. AU - Wai, Ka-Chung Abraham PY - 2022/7/14 TI - Virtual ER, a Serious Game for Interprofessional Education to Enhance Teamwork in Medical and Nursing Undergraduates: Development and Evaluation Study JO - JMIR Serious Games SP - e35269 VL - 10 IS - 3 KW - game KW - interprofessional education KW - teamwork KW - learning style KW - emergency medicine KW - emergency nursing N2 - Background: Engaging students in interprofessional education for higher order thinking and collaborative problem-solving skills is challenging. This study reports the development of Virtual ER, a serious game played on a virtual platform, and how it can be an innovative way for delivering interprofessional education to medical and nursing undergraduates. Objective: We report the development of a serious online game, Virtual ER, and evaluate its effect on teamwork enhancement and clinical competence. We also explore if Virtual ER can be an effective pedagogical tool to engage medical and nursing students with different learning styles. Methods: Virtual ER is a custom-made, learning outcome?driven, case-based web app. We developed a game performance scoring system with specific mechanisms to enhance serious gaming elements. Sixty-two students were recruited from our medical and nursing programs. They played the games in teams of 4 or 5, followed by an instructor-led debriefing for concept consolidation. Teamwork attitudes, as measured by the Human Factors Attitude Survey, were compared before and after the game. Learning style was measured with a modified Honey and Mumford learning style questionnaire. Results: Students were satisfied with Virtual ER (mean satisfaction score 5.44, SD 0.95, of a possible 7). Overall, Virtual ER enhanced teamwork attitude by 3.02 points (95% CI 1.15-4.88, P=.002). Students with higher scores as activists (estimate 9.09, 95% CI 5.17-13.02, P<.001) and pragmatists (estimate 5.69, 95% CI 1.18-10.20, P=.01) had a significantly higher degree of teamwork attitude enhancement, while students with higher scores as theorists and reflectors did not demonstrate significant changes. However, there was no difference in game performance scores between students with different learning styles. Conclusions: There was considerable teamwork enhancement after playing Virtual ER for interprofessional education, in particular for students who had activist or pragmatist learning styles. Serious online games have potential in interprofessional education for the development of 21st century life skills. Our findings also suggest that Virtual ER for interprofessional education delivery could be expanded locally and globally. UR - https://games.jmir.org/2022/3/e35269 UR - http://dx.doi.org/10.2196/35269 UR - http://www.ncbi.nlm.nih.gov/pubmed/35834309 ID - info:doi/10.2196/35269 ER - TY - JOUR AU - Kiyozumi, Tetsuro AU - Ishigami, Norio AU - Tatsushima, Daisuke AU - Araki, Yoshiyuki AU - Yoshimura, Yuya AU - Saitoh, Daizoh PY - 2022/6/29 TI - Instructor Development Workshops for Advanced Life Support Training Courses Held in a Fully Virtual Space: Observational Study JO - JMIR Serious Games SP - e38952 VL - 10 IS - 2 KW - virtual reality KW - virtual space KW - instructor development workshop KW - resuscitation training course KW - advanced life support KW - resuscitation training KW - digital training KW - virtual learning KW - digital education KW - medical education N2 - Background: Various face-to-face training opportunities have been lost due to the COVID-19 pandemic. Instructor development workshops for advanced resuscitation (ie, advanced life support) training courses are no exception. Virtual reality (VR) is an attractive strategy for remote training. However, to our knowledge, there are no reports of resuscitation instructor training programs being held in a virtual space. Objective: This study aimed to investigate the learning effects of an instructor development workshop that was conducted in a virtual space. Methods: In this observational study, we created a virtual workshop space by using NEUTRANS (Synamon Inc)?a commercial VR collaboration service. The instructor development workshop for the advanced life support training course was held in a virtual space (ie, termed the VR course) as a certified workshop by the Japanese Association of Acute Medicine. We asked 13 instructor candidates (students) who participated in the VR course to provide a workshop report (VR group). Reports from a previously held face-to-face workshop (ie, the face-to-face course and group) were likewise prepared for comparison. A total of 5 certified instructor trainers viewed and scored the reports on a 5-point Likert scale. Results: All students completed the VR course without any problems and received certificates of completion. The scores for the VR group and the face-to-face group did not differ at the level of statistical significance (median 3.8, IQR 3.8-4.0 and median 4.2, IQR 3.9-4.2, respectively; P=.41). Conclusions: We successfully conducted an instructor development workshop in a virtual space. The degree of learning in the virtual workshop was the same as that in the face-to-face workshop. UR - https://games.jmir.org/2022/2/e38952 UR - http://dx.doi.org/10.2196/38952 UR - http://www.ncbi.nlm.nih.gov/pubmed/35767318 ID - info:doi/10.2196/38952 ER - TY - JOUR AU - Button, Brenton AU - Cook, Clare AU - Goertzen, James AU - Cameron, Erin PY - 2022/6/13 TI - A Novel, Combined Student and Preceptor Professional Development Session for Optimizing Feedback: Protocol for a Multimethod, Multisite, and Multiyear Intervention JO - JMIR Res Protoc SP - e32829 VL - 11 IS - 6 KW - feedback KW - professional development KW - undergraduate KW - medical education KW - intervention KW - preceptors KW - students KW - medical students KW - longitudinal integrated clerkship N2 - Background: Providing feedback to medical learners is a critical educational activity. Despite the recognition of its importance, most research has focused on training preceptors to give feedback, which neglects the role of learners in receiving feedback. Delivering a combined professional development session for both preceptors and students may facilitate more effective feedback communication and improve both the quality and quantity of feedback. Objective: The objective of our research project is to examine the impact of a relational feedback intervention on both preceptors and students during a longitudinal integrated clerkship. Methods: Students and preceptors will attend a 2.5-hour combined professional development session, wherein they will be provided with educational tools for giving and receiving feedback within a coaching relationship and practice feedback giving and receiving skills together. Before the combined professional development session, students will be asked to participate in a 1-hour preparation session that will provide an orientation on their role in receiving feedback and their participation in the combined professional development session. Students and preceptors will be asked to complete a precombined professional development session survey and an immediate postcombined professional development session survey. Preceptors will be asked to complete a follow-up assessment survey, and students will be asked to participate in a follow-up, student-only focus group. Anonymized clinical faculty teaching evaluations and longitudinal integrated clerkship program evaluations will also be used to assess the impact of the intervention. Results: As of March 1, 2022, a total of 66 preceptors and 29 students have completed the baseline and follow-up measures. Data collection is expected to conclude in December 2023. Conclusions: Our study is designed to contribute to the literature on the feedback process between preceptors and students within a clinical setting. Including both the preceptors and the students in the same session will improve on the work that has already been conducted in this area, as the students and preceptors can further develop their relationships and coconstruct feedback conversations. We will use social learning theory to interpret the results of our study, which will help us explain the results and potentially make the work generalizable to other fields. International Registered Report Identifier (IRRID): DERR1-10.2196/32829 UR - https://www.researchprotocols.org/2022/6/e32829 UR - http://dx.doi.org/10.2196/32829 UR - http://www.ncbi.nlm.nih.gov/pubmed/35583554 ID - info:doi/10.2196/32829 ER - TY - JOUR AU - Shah, Savan PY - 2022/5/26 TI - Evaluation of Online Near-Peer Teaching for Penultimate-Year Objective Structured Clinical Examinations in the COVID-19 Era: Longitudinal Study JO - JMIR Med Educ SP - e37872 VL - 8 IS - 2 KW - near-peer teaching KW - peer-assisted learning KW - Objective Structured Clinical Examination KW - OSCE KW - online teaching KW - COVID-19 KW - medical education KW - learning KW - medical school KW - near-peer teacher KW - NPT KW - near-peer learner KW - NPL N2 - Background: The benefits of near-peer learning are well established in several aspects of undergraduate medical education including preparing students for Objective Structured Clinical Examinations (OSCEs). The COVID-19 pandemic has resulted in a paradigm shift to predominantly online teaching. Objective: This study aims to demonstrate the feasibility and benefits of an exclusively online near-peer OSCE teaching program in a time of significant face-to-face and senior-led teaching shortage. Methods: A teaching program was delivered to penultimate-year students by final-year students at Manchester Medical School. Program development involved compiling a list of salient topics and seeking senior faculty approval. Teachers and students were recruited on Facebook. In total, 22 sessions and 42 talks were attended by 72 students and taught by 13 teachers over a 3-month period. Data collection involved anonymous weekly questionnaires and 2 separate anonymous student and teacher postcourse questionnaires including both quantitative and qualitative components. Results: On a scale of 1-10, students rated the quality of the program highly (mean 9.30, SD 1.15) and felt the sessions were highly useful in guiding their revision (mean 8.95, SD 0.94). There was a significant increase in perceived confidence ratings after delivery of the program (P<.001). Teachers felt the program helped them better understand and retain the subject material taught (mean 9.36, SD 0.81) and develop skills to become effective clinical teachers (mean 9.27, SD 0.79). Conclusions: This is the first study demonstrating the efficacy of a near-peer OSCE teaching program delivered exclusively online. This provides an exemplary framework for how similar programs should be encouraged given their efficacy and logistical viability in supplementing the undergraduate curriculum. UR - https://mededu.jmir.org/2022/2/e37872 UR - http://dx.doi.org/10.2196/37872 UR - http://www.ncbi.nlm.nih.gov/pubmed/35617013 ID - info:doi/10.2196/37872 ER - TY - JOUR AU - Ajab, Shereen AU - Pearson, Emma AU - Dumont, Steven AU - Mitchell, Alicia AU - Kastelik, Jack AU - Balaji, Packianathaswamy AU - Hepburn, David PY - 2022/5/9 TI - An Alternative to Traditional Bedside Teaching During COVID-19: High-Fidelity Simulation-Based Study JO - JMIR Med Educ SP - e33565 VL - 8 IS - 2 KW - simulation KW - high fidelity KW - low fidelity KW - COVID-19 KW - bedside teaching KW - undergraduate medical education KW - fidelity KW - medical education KW - medical student KW - review KW - innovation KW - risk KW - design KW - implementation N2 - Background: Bedside teaching is integral to medical education and has been highlighted to improve clinical and communication skills, as well as clinical reasoning. Despite the significant advantages of bedside teaching, its usage within medical education has been declining, and COVID-19 has added additional challenges. The pandemic has resulted in a significant reduction in opportunities to deliver bedside teaching due to risk of viral exposure, patients declining student interactions, and ward closures. Educators have therefore been required to be innovative in their teaching methods, leading to the use of online learning, social media platforms, and simulation. Simulation-based education allows for learning in a low-risk environment and affords the opportunity for deliberated repeated practice with case standardization. The results demonstrate that simulation-based training can increase students? confidence, increase the rates of correct clinical diagnoses, and improve retention of skills and knowledge when compared with traditional teaching methods. Objective: To mitigate the impact of COVID-19 upon bedside teaching for third year students at Hull York Medical School amid closure of the cardiorespiratory wards, a high-fidelity simulation-based model of traditional bedside teaching was designed and implemented. The objectives of the teaching session were to enable students to perform history taking and a focused cardiorespiratory clinical examination in a COVID-19?safe environment using SimMan 3G. Methods: Four clinical teaching fellows with experience of simulation-based medical education scripted histories for 2 common cardiorespiratory cases, which were asthma and aortic stenosis. The simulation sessions were designed for students to take a focused cardiorespiratory history and clinical examination using SimMan 3G. All cases involved dynamic vital signs, and the simulator allowed for auscultation of an ejection systolic murmur and wheezing in accordance with the cases chosen. Key aspects of the pathologies, including epidemiology, differential diagnoses, investigations, and management, were summarized using an interactive PowerPoint presentation, followed by a debriefing session. Results: In total, 12 third year medical students undertook the sessions, and overall feedback was highly positive. Of the 10 students who completed the feedback questionnaires, 90% (n=9) felt more confident in their clinical examination skills following the teaching; 100% (n=10) of the students responded that they would recommend the session to a colleague; and implementation of regular simulation was frequently requested on feedback. These results are in keeping with the current literature. Conclusions: Bedside teaching continues to face ongoing challenges from the COVID-19 pandemic as well as declining patient recruitment and fluctuations in clinical findings. The support for simulation-based medical education is derived from high-quality studies; however, studies describing the use of this technology for bedside teaching in the undergraduate curriculum are limited. The authors describe a highly effective teaching session amid the pandemic, which allowed for maintenance of staff and student safety alongside continued education during a challenging time for educators globally. UR - https://mededu.jmir.org/2022/2/e33565 UR - http://dx.doi.org/10.2196/33565 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404828 ID - info:doi/10.2196/33565 ER - TY - JOUR AU - Rodriguez-Ferrer, M. Jose AU - Manzano-León, Ana AU - Cangas, J. Adolfo AU - Aguilar-Parra, M. Jose PY - 2022/5/5 TI - A Web-Based Escape Room to Raise Awareness About Severe Mental Illness Among University Students: Randomized Controlled Trial JO - JMIR Serious Games SP - e34222 VL - 10 IS - 2 KW - escape room KW - severe mental disorder KW - higher education KW - nursing education KW - mental health KW - mental disorder KW - serious games N2 - Background: People with severe mental illness (SMI) face discriminatory situations because of prejudice toward them, even among health care personnel. Escape rooms can be a novel educational strategy for learning about and empathizing with SMI, thus reducing stigma among health care students. Objective: This study aimed to examine the effect of the Without Memories escape room on nursing students? stigma against SMI. Methods: A pre- and postintervention study was conducted with a control group and an experimental group. A total of 306 students from 2 Andalusian universities participated in the study. Data were collected through a pre-post study questionnaire, consisting of an adapted version of the Attributional Style Questionnaire and a questionnaire on motivation for cooperative playful learning strategies. The control group carried out an escape room scenario without sensitizing content, whereas the experimental group carried out an escape room scenario on SMI, with both escape rooms being carried out in a 1-hour session of subjects related to mental health. To answer the research questions, a 2-way analysis of variance with repeated measures, a linear regression, and a 2-way analysis of variance were performed. Results: After the intervention, a significant reduction (P<.001) was observed in the experimental group in stigmatizing attitudes compared with the control group, in which no statistically significant changes (P>.05) were observed. In contrast, the linear regression (t195=?22.15; P<.001) showed that there was an inverse relationship between flow and the level of reduced stigma. When controlling for having or not having a close relative, the intervention was also shown to be effective (P<.001) in reducing the stigma displayed, both for people with affected and unaffected relatives. Conclusions: Our findings suggest that the Without Memories escape room can be used as an effective tool to educate and raise awareness about stigmatizing attitudes toward SMI in university students studying health care. Future testing of the effectiveness of educational escape rooms should be designed with new programs through playful strategies of longer duration to evaluate whether they can achieve a greater impact on motivation, acquisition of knowledge, and awareness. In addition, the feasibility of implementing the Without Memories escape room in other careers related to health and community should be investigated. UR - https://games.jmir.org/2022/2/e34222 UR - http://dx.doi.org/10.2196/34222 UR - http://www.ncbi.nlm.nih.gov/pubmed/35511232 ID - info:doi/10.2196/34222 ER - TY - JOUR AU - Chua, Ling Wei AU - Ooi, Leng Sim AU - Chan, Han Gene Wai AU - Lau, Ching Tang AU - Liaw, Ying Sok PY - 2022/4/18 TI - The Effect of a Sepsis Interprofessional Education Using Virtual Patient Telesimulation on Sepsis Team Care in Clinical Practice: Mixed Methods Study JO - J Med Internet Res SP - e35058 VL - 24 IS - 4 KW - sepsis KW - interprofessional education KW - team training KW - nurse-physician communication KW - simulation KW - telesimulation N2 - Background: Improving interprofessional communication and collaboration is necessary to facilitate the early identification and treatment of patients with sepsis. Preparing undergraduate medical and nursing students for the knowledge and skills required to assess, escalate, and manage patients with sepsis is crucial for their entry into clinical practice. However, the COVID-19 pandemic and social distancing measures have created the need for interactive distance learning to support collaborative learning. Objective: This study aimed to evaluate the effect of sepsis interprofessional education on medical and nursing students? sepsis knowledge, team communication skills, and skill use in clinical practice. Methods: A mixed methods design using a 1-group pretest-posttest design and focus group discussions was used. This study involved 415 undergraduate medical and nursing students from a university in Singapore. After a baseline evaluation of the participants? sepsis knowledge and team communication skills, they underwent didactic e-learning followed by virtual telesimulation on early recognition and management of sepsis and team communication strategies. The participants? sepsis knowledge and team communication skills were evaluated immediately and 2 months after the telesimulation. In total, 4 focus group discussions were conducted using a purposive sample of 18 medical and nursing students to explore their transfer of learning to clinical practice. Results: Compared with the baseline scores, both the medical and nursing students demonstrated a significant improvement in sepsis knowledge (P<.001) and team communication skills (P<.001) in immediate posttest scores. At the 2-month follow-up, the nursing students continued to have statistically significantly higher sepsis knowledge (P<.001) and communication scores (P<.001) than the pretest scores, whereas the medical students had no significant changes in test scores between the 2-month follow-up and pretest time points (P=.99). A total of three themes emerged from the qualitative findings: greater understanding of each other?s roles, application of mental models in clinical practice, and theory-practice gaps. The sepsis interprofessional education?particularly the use of virtual telesimulation?fostered participants? understanding and appreciation of each other?s interprofessional roles when caring for patients with sepsis. Despite noting some incongruities with the real-world clinical practice and not encountering many sepsis scenarios in clinical settings, participants shared the application of mental models using interprofessional communication strategies and the patient assessment framework in their daily clinical practice. Conclusions: Although the study did not show long-term knowledge retention, the use of virtual telesimulation played a critical role in facilitating the application of mental models for learning transfer and therefore could serve as a promising education modality for sepsis training. For a greater clinical effect, future studies could complement virtual telesimulation with a mannequin-based simulation and provide more evidence on the long-term retention of sepsis knowledge and clinical skills performance. UR - https://www.jmir.org/2022/4/e35058 UR - http://dx.doi.org/10.2196/35058 UR - http://www.ncbi.nlm.nih.gov/pubmed/35436237 ID - info:doi/10.2196/35058 ER - TY - JOUR AU - Van Gaalen, J. A. E. AU - Schönrock-Adema, J. AU - Renken, J. R. AU - Jaarsma, C. A. D. AU - Georgiadis, R. J. PY - 2022/4/4 TI - Identifying Player Types to Tailor Game-Based Learning Design to Learners: Cross-sectional Survey using Q Methodology JO - JMIR Serious Games SP - e30464 VL - 10 IS - 2 KW - gamification KW - serious games KW - game-based learning KW - medical education KW - computers KW - new technology KW - focus group KW - play KW - qualitative KW - player types KW - taxonomy KW - theory KW - framework N2 - Background: Game-based learning appears to be a promising instructional method because of its engaging properties and positive effects on motivation and learning. There are numerous options to design game-based learning; however, there is little data-informed knowledge to guide the choice of the most effective game-based learning design for a given educational context. The effectiveness of game-based learning appears to be dependent on the degree to which players like the game. Hence, individual differences in game preferences should be taken into account when selecting a specific game-based learning design. Objective: We aimed to identify patterns in students? perceptions of play and games?player types and their most important characteristics. Methods: We used Q methodology to identify patterns in opinions on game preferences. We recruited undergraduate medical and dental students to participate in our study and asked participants to sort and rank 49 statements on game preferences. These statements were derived from a prior focus group study and literature on game preferences. We used by-person factor analysis and varimax rotation to identify common viewpoints. Both factors and participants? comments were used to interpret and describe patterns in game preferences. Results: From participants? (n=102) responses, we identified 5 distinct patterns in game preferences: the social achiever, the explorer, the socializer, the competitor, and the troll. These patterns revolved around 2 salient themes: sociability and achievement. The 5 patterns differed regarding cheating, playing alone, story-telling, and the complexity of winning. Conclusions: The patterns were clearly interpretable, distinct, and showed that medical and dental students ranged widely in how they perceive play. Such patterns may suggest that it is important to take students? game preferences into account when designing game-based learning and demonstrate that not every game-based learning-strategy fits all students. To the best of our knowledge, this study is the first to use a scientifically sound approach to identify player types. This can help future researchers and educators select effective game-based learning game elements purposefully and in a student-centered way. UR - https://games.jmir.org/2022/2/e30464 UR - http://dx.doi.org/10.2196/30464 UR - http://www.ncbi.nlm.nih.gov/pubmed/35377333 ID - info:doi/10.2196/30464 ER - TY - JOUR AU - Wang, Jiaqi Judy AU - Singh, K. Rishabh AU - Miselis, Hough Heather AU - Stapleton, Nicole Stephanie PY - 2022/3/31 TI - Technology Literacy in Undergraduate Medical Education: Review and Survey of the US Medical School Innovation and Technology Programs JO - JMIR Med Educ SP - e32183 VL - 8 IS - 1 KW - curricular development KW - medical innovation KW - medical technology KW - student engagement N2 - Background: Modern innovations, like machine learning, genomics, and digital health, are being integrated into medical practice at a rapid pace. Physicians in training receive little exposure to the implications, drawbacks, and methodologies of upcoming technologies prior to their deployment. As a result, there is an increasing need for the incorporation of innovation and technology (I&T) training, starting in medical school. Objective: We aimed to identify and describe curricular and extracurricular opportunities for innovation in medical technology in US undergraduate medical education to highlight challenges and develop insights for future directions of program development. Methods: A review of publicly available I&T program information on the official websites of US allopathic medical schools was conducted in June 2020. Programs were categorized by structure and implementation. The geographic distribution of these categories across US regions was analyzed. A survey was administered to school-affiliated student organizations with a focus on I&T and publicly available contact information. The data collected included the founding year, thematic focus, target audience, activities offered, and participant turnout rate. Results: A total of 103 I&T opportunities at 69 distinct Liaison Committee on Medical Education?accredited medical schools were identified and characterized into the following six categories: (1) integrative 4-year curricula, (2) facilitated doctor of medicine/master of science dual degree programs in a related field, (3) interdisciplinary collaborations, (4) areas of concentration, (5) preclinical electives, and (6) student-run clubs. The presence of interdisciplinary collaboration is significantly associated with the presence of student-led initiatives (P=.001). ?Starting and running a business in healthcare? and ?medical devices? were the most popular thematic focuses of student-led I&T groups, representing 87% (13/15) and 80% (12/15) of respondents, respectively. ?Career pathways exploration for students? was the only type of activity that was significantly associated with a high event turnout rate of >26 students per event (P=.03). Conclusions: Existing school-led and student-driven opportunities in medical I&T indicate growing national interest and reflect challenges in implementation. The greater visibility of opportunities, collaboration among schools, and development of a centralized network can be considered to better prepare students for the changing landscape of medical practice. UR - https://mededu.jmir.org/2022/1/e32183 UR - http://dx.doi.org/10.2196/32183 UR - http://www.ncbi.nlm.nih.gov/pubmed/35357319 ID - info:doi/10.2196/32183 ER - TY - JOUR AU - Balaji, Aanika AU - Clever, Lou Sarah PY - 2022/3/11 TI - Authors? Reply to: Techniques to Teach Students Effectively Using Telemedicine. Comment on ?Incorporating Medical Students Into Primary Care Telehealth Visits: Tutorial? JO - JMIR Med Educ SP - e37401 VL - 8 IS - 1 KW - medical student KW - education KW - primary care KW - telehealth KW - video visits KW - internal medicine KW - medical education KW - teleconsultation KW - digital health KW - COVID-19 KW - teaching KW - telemedicine KW - clerkships UR - https://mededu.jmir.org/2022/1/e37401 UR - http://dx.doi.org/10.2196/37401 UR - http://www.ncbi.nlm.nih.gov/pubmed/35191840 ID - info:doi/10.2196/37401 ER - TY - JOUR AU - Kandola, Hardeep AU - Minhas, Sonica PY - 2022/3/11 TI - Techniques to Teach Students Effectively Using Telemedicine. Comment on ?Incorporating Medical Students Into Primary Care Telehealth Visits: Tutorial? JO - JMIR Med Educ SP - e30703 VL - 8 IS - 1 KW - medical student KW - education KW - primary care KW - telehealth KW - video visits KW - internal medicine KW - medical education KW - teleconsultation KW - digital health KW - COVID-19 KW - teaching KW - telemedicine KW - clerkships UR - https://mededu.jmir.org/2022/1/e30703 UR - http://dx.doi.org/10.2196/30703 UR - http://www.ncbi.nlm.nih.gov/pubmed/35191846 ID - info:doi/10.2196/30703 ER - TY - JOUR AU - Ozkara, Berksu Burak AU - Karabacak, Mert AU - Alpaydin, Demet Duygu PY - 2022/3/7 TI - Student-Run Online Journal Club Initiative During a Time of Crisis: Survey Study JO - JMIR Med Educ SP - e33612 VL - 8 IS - 1 KW - online journal club KW - medical student KW - distance learning KW - COVID-19 KW - undergraduate education KW - student journal club KW - online education KW - establishment KW - initiative KW - literature KW - research KW - publishing KW - education N2 - Background: Since the closure of university campuses due to COVID-19 in spring 2020 necessitated a quick transition to online courses, medical students were isolated from hospitals and universities, negatively impacting their education. During this time, medical students had no opportunity to participate in academic discussions and were also socially isolated. Furthermore, medical doctors and professors of medical schools were given additional responsibilities during the pandemic because they were the frontliners in the fight against COVID-19. As a result, they did not have enough time to contribute effectively to medical student education. Objective: This paper describes the establishment of the Cerrahpasa Neuroscience Society Journal Clubs, a group of entirely student-run online journal clubs at Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa. Methods: The website, mass emailing, and social media accounts were used to announce the online journal clubs. Only medical students were eligible to apply. Journal clubs included psychiatry, neuroradiology, neurosurgery, neurology, and neuroscience. Following the last journal club meeting, a questionnaire created by the society?s board was distributed to the participants. SPSS Statistics (version 26) was used for statistical analysis. Results: Since March 15, 2021, synchronous online journal club meetings have been held every 2 weeks on a weekday using Google Meet, Microsoft Teams, or Zoom. Meetings of each journal club lasted approximately 1 hour on average. Interstudent interaction across multiple institutions was achieved since a total of 45 students from 11 different universities attended the meetings on a regular basis. Students on the society?s board served as academic mentors for the clubs. The clubs received excellent feedback from participants, with an overall contentment score of 4.32 out of 5. Conclusions: By establishing these clubs, we have created a venue for academic discussions, which helps to reduce the negative impact of the pandemic on education. In addition, we believe it greatly aided students in staying in touch with their peers, thereby reducing the sense of isolation. We realize that traditional journal clubs are run by faculty; however, we believe that this experience demonstrated that medical students could run a journal club on their own since the feedback from participants was excellent. Additionally, as a medical student, being a journal club academic mentor is a challenging responsibility; however, having this responsibility significantly improved our academic mentors? leadership abilities. UR - https://mededu.jmir.org/2022/1/e33612 UR - http://dx.doi.org/10.2196/33612 UR - http://www.ncbi.nlm.nih.gov/pubmed/35148270 ID - info:doi/10.2196/33612 ER - TY - JOUR AU - Furlan, Raffaello AU - Gatti, Mauro AU - Mene, Roberto AU - Shiffer, Dana AU - Marchiori, Chiara AU - Giaj Levra, Alessandro AU - Saturnino, Vincenzo AU - Brunetta, Enrico AU - Dipaola, Franca PY - 2022/3/3 TI - Learning Analytics Applied to Clinical Diagnostic Reasoning Using a Natural Language Processing?Based Virtual Patient Simulator: Case Study JO - JMIR Med Educ SP - e24372 VL - 8 IS - 1 KW - clinical diagnostic reasoning KW - learning analytics KW - natural language processing KW - virtual patient simulator KW - medical education KW - medical knowledge N2 - Background: Virtual patient simulators (VPSs) log all users? actions, thereby enabling the creation of a multidimensional representation of students? medical knowledge. This representation can be used to create metrics providing teachers with valuable learning information. Objective: The aim of this study is to describe the metrics we developed to analyze the clinical diagnostic reasoning of medical students, provide examples of their application, and preliminarily validate these metrics on a class of undergraduate medical students. The metrics are computed from the data obtained through a novel VPS embedding natural language processing techniques. Methods: A total of 2 clinical case simulations (tests) were created to test our metrics. During each simulation, the students? step-by-step actions were logged into the program database for offline analysis. The students? performance was divided into seven dimensions: the identification of relevant information in the given clinical scenario, history taking, physical examination, medical test ordering, diagnostic hypothesis setting, binary analysis fulfillment, and final diagnosis setting. Sensitivity (percentage of relevant information found) and precision (percentage of correct actions performed) metrics were computed for each issue and combined into a harmonic mean (F1), thereby obtaining a single score evaluating the students? performance. The 7 metrics were further grouped to reflect the students? capability to collect and to analyze information to obtain an overall performance score. A methodological score was computed based on the discordance between the diagnostic pathway followed by students and the reference one previously defined by the teacher. In total, 25 students attending the fifth year of the School of Medicine at Humanitas University underwent test 1, which simulated a patient with dyspnea. Test 2 dealt with abdominal pain and was attended by 36 students on a different day. For validation, we assessed the Spearman rank correlation between the performance on these scores and the score obtained by each student in the hematology curricular examination. Results: The mean overall scores were consistent between test 1 (mean 0.59, SD 0.05) and test 2 (mean 0.54, SD 0.12). For each student, the overall performance was achieved through a different contribution in collecting and analyzing information. Methodological scores highlighted discordances between the reference diagnostic pattern previously set by the teacher and the one pursued by the student. No significant correlation was found between the VPS scores and hematology examination scores. Conclusions: Different components of the students? diagnostic process may be disentangled and quantified by appropriate metrics applied to students? actions recorded while addressing a virtual case. Such an approach may help teachers provide students with individualized feedback aimed at filling competence drawbacks and methodological inconsistencies. There was no correlation between the hematology curricular examination score and any of the proposed scores as these scores address different aspects of students? medical knowledge. UR - https://mededu.jmir.org/2022/1/e24372 UR - http://dx.doi.org/10.2196/24372 UR - http://www.ncbi.nlm.nih.gov/pubmed/35238786 ID - info:doi/10.2196/24372 ER - TY - JOUR AU - Schnieders, Elena AU - Röhr, Freda AU - Mbewe, Misho AU - Shanzi, Aubrey AU - Berner-Rodoreda, Astrid AU - Barteit, Sandra AU - Louis, R. Valérie AU - Andreadis, Petros AU - Syakantu, Gardner AU - Neuhann, Florian PY - 2022/2/24 TI - Real-life Evaluation of an Interactive Versus Noninteractive e-Learning Module on Chronic Obstructive Pulmonary Disease for Medical Licentiate Students in Zambia: Web-Based, Mixed Methods Randomized Controlled Trial JO - JMIR Med Educ SP - e34751 VL - 8 IS - 1 KW - distance education KW - randomized controlled trial KW - personal satisfaction KW - knowledge KW - user-centered design KW - chronic obstructive pulmonary disease KW - interactive KW - noninteractive KW - low- and middle-income country KW - LMIC KW - mobile phone N2 - Background: e-Learning for health professionals in many low- and middle-income countries (LMICs) is still in its infancy, but with the advent of COVID-19, a significant expansion of digital learning has occurred. Asynchronous e-learning can be grouped into interactive (user-influenceable content) and noninteractive (static material) e-learning. Studies conducted in high-income countries suggest that interactive e-learning is more effective than noninteractive e-learning in increasing learner satisfaction and knowledge; however, there is a gap in our understanding of whether this also holds true in LMICs. Objective: This study aims to validate the hypothesis above in a resource-constrained and real-life setting to understand e-learning quality and delivery by comparing interactive and noninteractive e-learning user satisfaction, usability, and knowledge gain in a new medical university in Zambia. Methods: We conducted a web-based, mixed methods randomized controlled trial at the Levy Mwanawasa Medical University (LMMU) in Lusaka, Zambia, between April and July 2021. We recruited medical licentiate students (second, third, and fourth study years) via email. Participants were randomized to undergo asynchronous e-learning with an interactive or noninteractive module for chronic obstructive pulmonary disease and informally blinded to their group allocation. The interactive module included interactive interfaces, quizzes, and a virtual patient, whereas the noninteractive module consisted of PowerPoint slides. Both modules covered the same content scope. The primary outcome was learner satisfaction. The secondary outcomes were usability, short- and long-term knowledge gain, and barriers to e-learning. The mixed methods study followed an explanatory sequential design in which rating conferences delivered further insights into quantitative findings, which were evaluated through web-based questionnaires. Results: Initially, 94 participants were enrolled in the study, of whom 41 (44%; 18 intervention participants and 23 control participants) remained in the study and were analyzed. There were no significant differences in satisfaction (intervention: median 33.5, first quartile 31.3, second quartile 35; control: median 33, first quartile 30, second quartile 37.5; P=.66), usability, or knowledge gain between the intervention and control groups. Challenges in accessing both e-learning modules led to many dropouts. Qualitative data suggested that the content of the interactive module was more challenging to access because of technical difficulties and individual factors (eg, limited experience with interactive e-learning). Conclusions: We did not observe an increase in user satisfaction with interactive e-learning. However, this finding may not be generalizable to other low-resource settings because the post hoc power was low, and the e-learning system at LMMU has not yet reached its full potential. Consequently, technical and individual barriers to accessing e-learning may have affected the results, mainly because the interactive module was considered more difficult to access and use. Nevertheless, qualitative data showed high motivation and interest in e-learning. Future studies should minimize technical barriers to e-learning to further evaluate interactive e-learning in LMICs. UR - https://mededu.jmir.org/2022/1/e34751 UR - http://dx.doi.org/10.2196/34751 UR - http://www.ncbi.nlm.nih.gov/pubmed/35200149 ID - info:doi/10.2196/34751 ER - TY - JOUR AU - Ade-Ibijola, Abejide AU - Young, Keagan AU - Sivparsad, Nashik AU - Seforo, Mpho AU - Ally, Suhail AU - Olowolafe, Adebola AU - Frahm-Arp, Maria PY - 2022/2/16 TI - Teaching Students About Plagiarism Using a Serious Game (Plagi-Warfare): Design and Evaluation Study JO - JMIR Serious Games SP - e33459 VL - 10 IS - 1 KW - serious games KW - educational games KW - plagiarism KW - library games KW - game mechanics KW - education KW - teaching N2 - Background: Educational games have been proven to support the teaching of various concepts across disciplines. Plagiarism is a major problem among undergraduate and postgraduate students at universities. Objective: In this paper, we propose a game called Plagi-Warfare that attempts to teach students about plagiarism. Methods: To do this at a level that is beyond quizzes, we proposed a game storyline and mechanics that allow the player (or student) to play as a mafia member or a detective. This either demonstrated their knowledge by plagiarizing within the game as a mafia member or catching plagiarists within the game as a detective. The game plays out in a 3D environment representing the major libraries of the University of Johannesburg, South Africa. In total, 30 students were selected to evaluate the game. Results: Evaluation of the game mechanics and storyline showed that the student gamers enjoyed the game and learned about plagiarism. Conclusions: In this paper, we presented a new educational game that teaches students about plagiarism by using a new crime story and an immersive 3D gaming environment representing the libraries of the University of Johannesburg. UR - https://games.jmir.org/2022/1/e33459 UR - http://dx.doi.org/10.2196/33459 UR - http://www.ncbi.nlm.nih.gov/pubmed/35171103 ID - info:doi/10.2196/33459 ER - TY - JOUR AU - Samarasekara, Keshinie PY - 2022/2/10 TI - e-Learning in Medical Education in Sri Lanka: Survey of Medical Undergraduates and New Graduates JO - JMIR Med Educ SP - e22096 VL - 8 IS - 1 KW - medical education KW - e-learning KW - Sri Lanka KW - medical students N2 - Background: Medical education has undergone drastic changes with the advent of novel technologies that enable e-learning. Medical students are increasingly using e-learning methods, and universities have incorporated them into their curricula. Objective: This study aimed at delineating the pattern of use of e-learning methods among medical undergraduates and new graduates of the Faculty of Medicine, University of Colombo, and identifying the challenges faced by these students in using e-learning methods. Methods: A cross-sectional descriptive study was conducted in the Faculty of Medicine, University of Colombo, in April 2020, with the participation of current undergraduates and pre-intern medical graduates, using a self-administered questionnaire that collected data on sociodemographic details, pattern of use of learning methods, and challenges faced using e-learning methods. Results: There were 778 respondents, with a response rate of 65.1% (778/1195). All the study participants used e-learning resources with varying frequencies, and all of them had at least 1 smart device with access to the internet. Electronic versions of standard textbooks (e-books), nonmedical websites, online lectures, medical websites, and medical phone apps were used by the majority. When comparing the extent of use of different learning methods, it appeared that students preferentially used traditional learning methods. The preference was influenced by the year of study and family income. The 3 most commonly used modalities for learning new study material and revising previously learned content were notes on paper material, textbooks (paper version), and e-books. The majority (98.7% [n=768]) of participants have encountered problems using e-learning resources. The most commonly faced problems were unavailability of free-of-charge access to some e-learning methods, expenses related to internet connection, poor connectivity of mobile internet, distractions while using online resources, and lack of storage space on electronic devices. Conclusions: There is a high uptake of e-learning methods among Sri Lankan medical students. However, when comparing the extent of use of different learning methods, it appeared that students preferentially used traditional learning methods. A majority of the students have encountered problems when using e-learning methods, and most of these problems were related to poor economic status. Universities should take these factors into consideration when developing curricula in medical education. UR - https://mededu.jmir.org/2022/1/e22096 UR - http://dx.doi.org/10.2196/22096 UR - http://www.ncbi.nlm.nih.gov/pubmed/35142626 ID - info:doi/10.2196/22096 ER - TY - JOUR AU - Cosimini, Joseph Michael AU - Watsjold, Bjorn AU - Chan, M. Teresa PY - 2022/2/9 TI - Serious Games Without Screens. Comment on ?Involvement of End Users in the Development of Serious Games for Health Care Professions Education: Systematic Descriptive Review? JO - JMIR Serious Games SP - e34656 VL - 10 IS - 1 KW - game-based learning KW - health professions education KW - participatory design KW - systematic review KW - user-centered design KW - serious games KW - game development KW - end users KW - education UR - https://games.jmir.org/2022/1/e34656 UR - http://dx.doi.org/10.2196/34656 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138255 ID - info:doi/10.2196/34656 ER - TY - JOUR AU - Jiang, Haowen AU - Vimalesvaran, Sunitha AU - Wang, King Jeremy AU - Lim, Boon Kee AU - Mogali, Reddy Sreenivasulu AU - Car, Tudor Lorainne PY - 2022/2/2 TI - Virtual Reality in Medical Students? Education: Scoping Review JO - JMIR Med Educ SP - e34860 VL - 8 IS - 1 KW - virtual reality KW - medical education KW - medical students KW - virtual worlds KW - digital health education N2 - Background: Virtual reality (VR) produces a virtual manifestation of the real world and has been shown to be useful as a digital education modality. As VR encompasses different modalities, tools, and applications, there is a need to explore how VR has been used in medical education. Objective: The objective of this scoping review is to map existing research on the use of VR in undergraduate medical education and to identify areas of future research. Methods: We performed a search of 4 bibliographic databases in December 2020. Data were extracted using a standardized data extraction form. The study was conducted according to the Joanna Briggs Institute methodology for scoping reviews and reported in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: Of the 114 included studies, 69 (60.5%) reported the use of commercially available surgical VR simulators. Other VR modalities included 3D models (15/114, 13.2%) and virtual worlds (20/114, 17.5%), which were mainly used for anatomy education. Most of the VR modalities included were semi-immersive (68/114, 59.6%) and were of high interactivity (79/114, 69.3%). There is limited evidence on the use of more novel VR modalities, such as mobile VR and virtual dissection tables (8/114, 7%), as well as the use of VR for nonsurgical and nonpsychomotor skills training (20/114, 17.5%) or in a group setting (16/114, 14%). Only 2.6% (3/114) of the studies reported the use of conceptual frameworks or theories in the design of VR. Conclusions: Despite the extensive research available on VR in medical education, there continue to be important gaps in the evidence. Future studies should explore the use of VR for the development of nonpsychomotor skills and in areas other than surgery and anatomy. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-046986 UR - https://mededu.jmir.org/2022/1/e34860 UR - http://dx.doi.org/10.2196/34860 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107421 ID - info:doi/10.2196/34860 ER - TY - JOUR AU - Ryan, V. Grace AU - Callaghan, Shauna AU - Rafferty, Anthony AU - Higgins, F. Mary AU - Mangina, Eleni AU - McAuliffe, Fionnuala PY - 2022/2/1 TI - Learning Outcomes of Immersive Technologies in Health Care Student Education: Systematic Review of the Literature JO - J Med Internet Res SP - e30082 VL - 24 IS - 2 KW - Virtual Reality KW - Augmented Reality KW - Mixed Reality KW - Learning Outcomes KW - Medical Education KW - Nursing Education KW - Midwifery Education KW - Systematic Review N2 - Background: There is a lack of evidence in the literature regarding the learning outcomes of immersive technologies as educational tools for teaching university-level health care students. Objective: The aim of this review is to assess the learning outcomes of immersive technologies compared with traditional learning modalities with regard to knowledge and the participants? learning experience in medical, midwifery, and nursing preclinical university education. Methods: A systematic review was conducted according to the Cochrane Collaboration guidelines. Randomized controlled trials comparing traditional learning methods with virtual, augmented, or mixed reality for the education of medicine, nursing, or midwifery students were evaluated. The identified studies were screened by 2 authors independently. Disagreements were discussed with a third reviewer. The quality of evidence was assessed using the Medical Education Research Study Quality Instrument (MERSQI). The review protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews) in April 2020. Results: Of 15,627 studies, 29 (0.19%) randomized controlled trials (N=2722 students) were included and evaluated using the MERSQI tool. Knowledge gain was found to be equal when immersive technologies were compared with traditional learning modalities; however, the learning experience increased with immersive technologies. The mean MERSQI score was 12.64 (SD 1.6), the median was 12.50, and the mode was 13.50. Immersive technology was predominantly used to teach clinical skills (15/29, 52%), and virtual reality (22/29, 76%) was the most commonly used form of immersive technology. Knowledge was the primary outcome in 97% (28/29) of studies. Approximately 66% (19/29) of studies used validated instruments and scales to assess secondary learning outcomes, including satisfaction, self-efficacy, engagement, and perceptions of the learning experience. Of the 29 studies, 19 (66%) included medical students (1706/2722, 62.67%), 8 (28%) included nursing students (727/2722, 26.71%), and 2 (7%) included both medical and nursing students (289/2722, 10.62%). There were no studies involving midwifery students. The studies were based on the following disciplines: anatomy, basic clinical skills and history-taking skills, neurology, respiratory medicine, acute medicine, dermatology, communication skills, internal medicine, and emergency medicine. Conclusions: Virtual, augmented, and mixed reality play an important role in the education of preclinical medical and nursing university students. When compared with traditional educational modalities, the learning gain is equal with immersive technologies. Learning outcomes such as student satisfaction, self-efficacy, and engagement all increase with the use of immersive technology, suggesting that it is an optimal tool for education. UR - https://www.jmir.org/2022/2/e30082 UR - http://dx.doi.org/10.2196/30082 UR - http://www.ncbi.nlm.nih.gov/pubmed/35103607 ID - info:doi/10.2196/30082 ER - TY - JOUR AU - Teng, Minnie AU - Singla, Rohit AU - Yau, Olivia AU - Lamoureux, Daniel AU - Gupta, Aurinjoy AU - Hu, Zoe AU - Hu, Ricky AU - Aissiou, Amira AU - Eaton, Shane AU - Hamm, Camille AU - Hu, Sophie AU - Kelly, Dayton AU - MacMillan, M. Kathleen AU - Malik, Shamir AU - Mazzoli, Vienna AU - Teng, Yu-Wen AU - Laricheva, Maria AU - Jarus, Tal AU - Field, S. Thalia PY - 2022/1/31 TI - Health Care Students? Perspectives on Artificial Intelligence: Countrywide Survey in Canada JO - JMIR Med Educ SP - e33390 VL - 8 IS - 1 KW - medical education KW - artificial intelligence KW - allied health education KW - medical students KW - health care students KW - medical curriculum KW - education N2 - Background: Artificial intelligence (AI) is no longer a futuristic concept; it is increasingly being integrated into health care. As studies on attitudes toward AI have primarily focused on physicians, there is a need to assess the perspectives of students across health care disciplines to inform future curriculum development. Objective: This study aims to explore and identify gaps in the knowledge that Canadian health care students have regarding AI, capture how health care students in different fields differ in their knowledge and perspectives on AI, and present student-identified ways that AI literacy may be incorporated into the health care curriculum. Methods: The survey was developed from a narrative literature review of topics in attitudinal surveys on AI. The final survey comprised 15 items, including multiple-choice questions, pick-group-rank questions, 11-point Likert scale items, slider scale questions, and narrative questions. We used snowball and convenience sampling methods by distributing an email with a description and a link to the web-based survey to representatives from 18 Canadian schools. Results: A total of 2167 students across 10 different health professions from 18 universities across Canada responded to the survey. Overall, 78.77% (1707/2167) predicted that AI technology would affect their careers within the coming decade and 74.5% (1595/2167) reported a positive outlook toward the emerging role of AI in their respective fields. Attitudes toward AI varied by discipline. Students, even those opposed to AI, identified the need to incorporate a basic understanding of AI into their curricula. Conclusions: We performed a nationwide survey of health care students across 10 different health professions in Canada. The findings would inform student-identified topics within AI and their preferred delivery formats, which would advance education across different health care professions. UR - https://mededu.jmir.org/2022/1/e33390 UR - http://dx.doi.org/10.2196/33390 UR - http://www.ncbi.nlm.nih.gov/pubmed/35099397 ID - info:doi/10.2196/33390 ER - TY - JOUR AU - Herrera, Tara AU - Fiori, P. Kevin AU - Archer-Dyer, Heather AU - Lounsbury, W. David AU - Wylie-Rosett, Judith PY - 2022/1/17 TI - Social Determinants of Health Screening by Preclinical Medical Students During the COVID-19 Pandemic: Service-Based Learning Case Study JO - JMIR Med Educ SP - e32818 VL - 8 IS - 1 KW - social determinants of health KW - service-based learning KW - telehealth KW - preclinical education KW - screening KW - referral KW - community health workers KW - determinant KW - medical student KW - case study KW - service KW - preparation KW - pilot KW - feasibility KW - training KW - assessment KW - needs KW - electronic health record KW - questionnaire N2 - Background: The inclusion of social determinants of health is mandated for undergraduate medical education. However, little is known about how to prepare preclinical students for real-world screening and referrals for addressing social determinants of health. Objective: This pilot project?s objective was to evaluate the feasibility of using a real-world, service-based learning approach for training preclinical students to assess social needs and make relevant referrals via the electronic medical record during the COVID-19 pandemic (May to June 2020). Methods: This project was designed to address an acute community service need and to teach preclinical, second-year medical student volunteers (n=11) how to assess social needs and make referrals by using the 10-item Social Determinants of Health Screening Questionnaire in the electronic health record (EHR; Epic platform; Epic Systems Corporation). Third-year medical student volunteers (n=3), who had completed 6 clinical rotations, led the 2-hour skills development orientation and were available for ongoing mentoring and peer support. All student-patient communication was conducted by telephone, and bilingual (English and Spanish) students called the patients who preferred to communicate in Spanish. We analyzed EHR data extracted from Epic to evaluate screening and data extracted from REDCap (Research Electronic Data Capture; Vanderbilt University) to evaluate community health workers? notes. We elicited feedback from the participating preclinical students to evaluate the future use of this community-based service learning approach in our preclinical curriculum. Results: The preclinical students completed 45 screening interviews. Of the 45 screened patients, 20 (44%) screened positive for at least 1 social need. Almost all of these patients (19/20, 95%) were referred to the community health worker. Half (8/16, 50%) of the patients who had consultations with the community health worker were connected with a relevant social service resource. The preclinical students indicated that project participation increased their ability to assess social needs and make needed EHR referrals. Food insecurity was the most common social need. Conclusions: Practical exposure to social needs assessment has the potential to help preclinical medical students develop the ability to address social concerns prior to entering clinical clerkships in their third year of medical school. The students can also become familiar with the EHR prior to entering third-year clerkships. Physicians, who are aware of social needs and have the electronic medical record tools and staff resources needed to act, can create workflows to make social needs assessments and services integral components of health care. Research studies and quality improvement initiatives need to investigate how to integrate screening for social needs and connecting patients to the appropriate social services into routine primary care procedures. UR - https://mededu.jmir.org/2022/1/e32818 UR - http://dx.doi.org/10.2196/32818 UR - http://www.ncbi.nlm.nih.gov/pubmed/35037885 ID - info:doi/10.2196/32818 ER - TY - JOUR AU - Dederichs, Melina AU - Nitsch, Jan Felix AU - Apolinário-Hagen, Jennifer PY - 2022/1/10 TI - Piloting an Innovative Concept of e?Mental Health and mHealth Workshops With Medical Students Using a Participatory Co-design Approach and App Prototyping: Case Study JO - JMIR Med Educ SP - e32017 VL - 8 IS - 1 KW - participatory design KW - co-design KW - mHealth KW - medical student KW - eHealth KW - medical education KW - mental health KW - mobile phone N2 - Background: Medical students show low levels of e?mental health literacy. Moreover, there is a high prevalence of common mental illnesses among medical students. Mobile health (mHealth) apps can be used to maintain and promote medical students? well-being. To date, the potential of mHealth apps for promoting mental health among medical students is largely untapped because they seem to lack familiarity with mHealth. In addition, little is known about medical students? preferences regarding mHealth apps for mental health promotion. There is a need for guidance on how to promote competence-based learning on mHealth apps in medical education. Objective: The aim of this case study is to pilot an innovative concept for an educative workshop following a participatory co-design approach and to explore medical students? preferences and ideas for mHealth apps through the design of a hypothetical prototype. Methods: We conducted a face-to-face co-design workshop within an elective subject with 26 participants enrolled at a medical school in Germany on 5 consecutive days in early March 2020. The aim of the workshop was to apply the knowledge acquired from the lessons on e?mental health and mHealth app development. Activities during the workshop included group work, plenary discussions, storyboarding, developing personas (prototypical users), and designing prototypes of mHealth apps. The workshop was documented in written and digitalized form with the students? permission. Results: The participants? feedback suggests that the co-design workshop was well-received. The medical students presented a variety of ideas for the design of mHealth apps. Among the common themes that all groups highlighted in their prototypes were personalization, data security, and the importance of scientific evaluation. Conclusions: Overall, this case study indicates the feasibility and acceptance of a participatory design workshop for medical students. The students made suggestions for improvements at future workshops (eg, use of free prototype software, shift to e-learning, and more time for group work). Our results can be (and have already been) used as a starting point for future co-design workshops to promote competence-based collaborative learning on digital health topics in medical education. UR - https://mededu.jmir.org/2022/1/e32017 UR - http://dx.doi.org/10.2196/32017 UR - http://www.ncbi.nlm.nih.gov/pubmed/35006085 ID - info:doi/10.2196/32017 ER - TY - JOUR AU - Tan, Wen Jun AU - Ng, Bee Kian AU - Mogali, Reddy Sreenivasulu PY - 2022/1/10 TI - An Exploratory Digital Board Game Approach to the Review and Reinforcement of Complex Medical Subjects Like Anatomical Education: Cross-sectional and Mixed Methods Study JO - JMIR Serious Games SP - e33282 VL - 10 IS - 1 KW - serious games KW - board games KW - anatomy KW - flow N2 - Background: Serious games have the potential to resolve educational problems faced by medical students, such as insufficient rehearsal due to boredom and lack of motivation. However, serious games? relatively novel concepts in science and many genres of games that are common in recreation remain underresearched in the literature. Board games are one such genre that, despite their potential, affordability, and flexibility, are rarely designed for medical students, and little is known about student perceptions of them and their compatibility with rehearsal. Objective: In this cross-sectional study, we sought to elicit, via an exploratory mixed methods approach, student perceptions of a digital serious board game specifically designed for the gamified rehearsal of complex medical subjects, with the chosen topic of anatomy. Methods: A digital serious board game, based on self-determination theory (SDT), was first designed and developed to facilitate the rehearsal of anatomy information. Students were then voluntarily recruited to partake in the intervention and were randomly split into three teams of 2 players per game session, after which they were administered the Flow Short Scale (FSS), which is a 13-item measure where items were rated on a 7-point Likert scale ranging from 1 (?not at all?) to 7 (?very much?). Students then participated in a focus group discussion to elicit their perceptions of the game. Findings from the FSS were subject to descriptive analysis, and the focus group discussion was subject to inductive thematic analysis. Results: A total of 12 undergraduate, second-year medical students from the Lee Kong Chian School of Medicine in Singapore participated in the study. FSS results indicated a moderate level of overall flow (mean score 4.94, SD 1.07) via the subdomains of fluency (mean score 4.77, SD 1.13) and absorption (mean score 5.21, SD 1.1). Students perceived the game as fun, enjoyable, engaging, and appropriate as a rehearsal tool that alleviated the monotony of traditional methods of rehearsal. Conclusions: Our digital board game?based rehearsal tool, when based on SDT, appeared to be suitable for gamified rehearsal in a fun and enjoyable environment due to its facilitation of intrinsic motivation in its players. UR - https://games.jmir.org/2022/1/e33282 UR - http://dx.doi.org/10.2196/33282 UR - http://www.ncbi.nlm.nih.gov/pubmed/35006080 ID - info:doi/10.2196/33282 ER - TY - JOUR AU - Massanelli, Jackson AU - Sexton, W. Kevin AU - Lesher, T. Chris AU - Jensen, K. Hanna AU - Kimbrough, K. Mary AU - Privratsky, Anna AU - Taylor, R. John AU - Bhavaraju, Avi PY - 2021/12/13 TI - Integration of Web Analytics Into Graduate Medical Education: Usability Study JO - JMIR Form Res SP - e29748 VL - 5 IS - 12 KW - graduate medical education KW - website analysis KW - residency recruitment KW - medical education KW - website KW - analytics KW - usage KW - usability KW - user engagement KW - user-centered design KW - website design N2 - Background: Web analytics is the measurement, collection, analysis, and reporting of website and web application usage data. While common in the e-commerce arena, web analytics is underutilized in graduate medical education (GME). Objective: The University of Arkansas for Medical Sciences Department of Surgery website was revamped with input from in-house surgeons in August 2017. This study investigated the use of web analytics to gauge the impact of our department?s website redesign project. Methods: Google Analytics software was used to measure website performance before and after implementation of the new website. Eight-month matched periods were compared. Factors tracked included total users, new users, total sessions, sessions per user, pages per session, average session duration, total page views, and bounce rate (the percentage of visitors who visit a site and then leave [ie, bounce] without continuing to another page on the same site). Results: Analysis using a nonpaired Student t test demonstrated a statistically significant increase for total page views (before vs after: 33,065 vs 81,852; P<.001) and decrease for bounce rate (before vs after: 50.70% vs 0.23%; P<.001). Total users, new users, total sessions, sessions per user, and pages per session showed improvement. The average session duration was unchanged. Subgroup analysis showed that after the main page, the next 3 most frequently visited pages were related to GME programs in our department. Conclusions: Web analytics is a practical measure of a website?s efficacy. Our data suggest that a modern website significantly improves user engagement. An up-to-date website is essential for contemporary GME recruitment, will likely enhance engagement of residency applicants with GME programs, and warrants further investigation. UR - https://formative.jmir.org/2021/12/e29748 UR - http://dx.doi.org/10.2196/29748 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898459 ID - info:doi/10.2196/29748 ER - TY - JOUR AU - Chao, Yi-Ping AU - Chuang, Hai-Hua AU - Hsin, Li-Jen AU - Kang, Chung-Jan AU - Fang, Tuan-Jen AU - Li, Hsueh-Yu AU - Huang, Chung-Guei AU - Kuo, J. Terry B. AU - Yang, H. Cheryl C. AU - Shyu, Hsin-Yih AU - Wang, Shu-Ling AU - Shyu, Liang-Yu AU - Lee, Li-Ang PY - 2021/11/22 TI - Using a 360° Virtual Reality or 2D Video to Learn History Taking and Physical Examination Skills for Undergraduate Medical Students: Pilot Randomized Controlled Trial JO - JMIR Serious Games SP - e13124 VL - 9 IS - 4 KW - cognitive load KW - heart rate variability KW - video learning KW - learning outcome KW - secondary-task reaction time KW - virtual reality N2 - Background: Learning through a 360° virtual reality (VR) or 2D video represents an alternative way to learn a complex medical education task. However, there is currently no consensus on how best to assess the effects of different learning materials on cognitive load estimates, heart rate variability (HRV), outcomes, and experience in learning history taking and physical examination (H&P) skills. Objective: The aim of this study was to investigate how learning materials (ie, VR or 2D video) impact learning outcomes and experience through changes in cognitive load estimates and HRV for learning H&P skills. Methods: This pilot system?design study included 32 undergraduate medical students at an academic teaching hospital. The students were randomly assigned, with a 1:1 allocation, to a 360° VR video group or a 2D video group, matched by age, sex, and cognitive style. The contents of both videos were different with regard to visual angle and self-determination. Learning outcomes were evaluated using the Milestone reporting form. Subjective and objective cognitive loads were estimated using the Paas Cognitive Load Scale, the National Aeronautics and Space Administration Task Load Index, and secondary-task reaction time. Cardiac autonomic function was assessed using HRV measurements. Learning experience was assessed using the AttrakDiff2 questionnaire and qualitative feedback. Statistical significance was accepted at a two-sided P value of <.01. Results: All 32 participants received the intended intervention. The sample consisted of 20 (63%) males and 12 (38%) females, with a median age of 24 (IQR 23-25) years. The 360° VR video group seemed to have a higher Milestone level than the 2D video group (P=.04). The reaction time at the 10th minute in the 360° VR video group was significantly higher than that in the 2D video group (P<.001). Multiple logistic regression models of the overall cohort showed that the 360° VR video module was independently and positively associated with a reaction time at the 10th minute of ?3.6 seconds (exp B=18.8, 95% CI 3.2-110.8; P=.001) and a Milestone level of ?3 (exp B=15.0, 95% CI 2.3-99.6; P=.005). However, a reaction time at the 10th minute of ?3.6 seconds was not related to a Milestone level of ?3. A low-frequency to high-frequency ratio between the 5th and 10th minute of ?1.43 seemed to be inversely associated with a hedonic stimulation score of ?2.0 (exp B=0.14, 95% CI 0.03-0.68; P=.015) after adjusting for video module. The main qualitative feedback indicated that the 360° VR video module was fun but caused mild dizziness, whereas the 2D video module was easy to follow but tedious. Conclusions: Our preliminary results showed that 360° VR video learning may be associated with a better Milestone level than 2D video learning, and that this did not seem to be related to cognitive load estimates or HRV indexes in the novice learners. Of note, an increase in sympathovagal balance may have been associated with a lower hedonic stimulation score, which may have met the learners? needs and prompted learning through the different video modules. Trial Registration: ClinicalTrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641 UR - https://games.jmir.org/2021/4/e13124 UR - http://dx.doi.org/10.2196/13124 UR - http://www.ncbi.nlm.nih.gov/pubmed/34813485 ID - info:doi/10.2196/13124 ER - TY - JOUR AU - Koenig, Leni Julia Felicitas AU - Buentzel, Judith AU - Jung, Wolfram AU - Truemper, Lorenz AU - Wurm-Kuczera, Isabel Rebecca PY - 2021/11/15 TI - Using Instagram to Enhance a Hematology and Oncology Teaching Module During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Med Educ SP - e30607 VL - 7 IS - 4 KW - COVID-19 KW - medical education KW - distance learning KW - undergraduate medical education KW - digital medical education KW - Instagram KW - hematology and medical oncology N2 - Background: The COVID-19 pandemic necessitated the rapid expansion of novel tools for digital medical education. At our university medical center, an Instagram account was developed as a tool for medical education and used for the first time as a supplement to the hematology and medical oncology teaching module of 2020/2021. Objective: We aimed to evaluate the acceptance and role of Instagram as a novel teaching format in the education of medical students in hematology and medical oncology in the German medical curriculum. Methods: To investigate the role of Instagram in student education of hematology and medical oncology, an Instagram account was developed as a tie-in for the teaching module of 2020/21. The account was launched at the beginning of the teaching module, and 43 posts were added over the 47 days of the teaching module (at least 1 post per day). Five categories for the post content were established: (1) engagement, (2) self-awareness, (3) everyday clinical life combined with teaching aids, (4) teaching aids, and (5) scientific resources. Student interaction with the posts was measured based on overall subscription, ?likes,? comments, and polls. Approval to conduct this retrospective study was obtained from the local ethics commission of the University Medical Center Goettingen. Results: Of 164 medical students, 119 (72.6%) subscribed to the Instagram account, showing high acceptance and interest in the use of Instagram for medical education. The 43 posts generated 325 interactions. The highest number of interactions was observed for the category of engagement (mean 15.17 interactions, SD 5.01), followed by self-awareness (mean 14 interactions, SD 7.79). With an average of 7.3 likes per post, overall interaction was relatively low. However, although the category of scientific resources garnered the fewest likes (mean 1.86, SD 1.81), 66% (27/41) of the student participants who answered the related Instagram poll question were interested in studies and reviews, suggesting that although likes aid the estimation of a general trend of interest, there are facets to interest that cannot be represented by likes. Interaction significantly differed between posting categories (P<.001, Welch analysis of variance). Comparing the first category (engagement) with categories 3 to 5 showed a significant difference (Student t test with the Welch correction; category 1 vs 3, P=.01; category 1 vs 4, P=.01; category 1 vs 5, P=.001). Conclusions: Instagram showed high acceptance among medical students participating in the hematology and oncology teaching curriculum. Students were most interested in posts on routine clinical life, self-care topics, and memory aids. More studies need to be conducted to comprehend the use of Instagram in medical education and to define the role Instagram will play in the future. Furthermore, evaluation guidelines and tools need to be developed. UR - https://mededu.jmir.org/2021/4/e30607 UR - http://dx.doi.org/10.2196/30607 UR - http://www.ncbi.nlm.nih.gov/pubmed/34779777 ID - info:doi/10.2196/30607 ER - TY - JOUR AU - Zuo, Tianming AU - Sun, Baozhi AU - Guan, Xu AU - Zheng, Bin AU - Qu, Bo PY - 2021/11/9 TI - Evidence of Construct Validity of Computer-Based Tests for Clinical Reasoning: Instrument Validation Study JO - JMIR Serious Games SP - e17670 VL - 9 IS - 4 KW - medical education KW - assessment KW - computer-based test KW - clinical reasoning KW - validity N2 - Background: Clinical reasoning (CR) is a fundamental skill for all medical students. In our medical education system, however, there are shortcomings in the conventional methods of teaching CR. New technology is needed to enhance our CR teaching, especially as we are facing an influx of new health trainees. China Medical University (CMU), in response to this need, has developed a computer-based CR training system (CMU-CBCRT). Objective: We aimed to find evidence of construct validity of the CMU-CBCRT. Methods: We recruited 385 students from fifth year undergraduates to postgraduate year (PGY) 3 to complete the test on CMU-CBCRT. The known-groups technique was used to evaluate the construct validity of the CBCRT by comparing the test scores among 4 training levels (fifth year MD, PGY-1, PGY-2, and PGY-3). Results: We found that test scores increased with years of training. Significant differences were found in the test scores on information collection, diagnosis, and treatment and total scores among different training years of participants. However, significant results were not found for treatment errors. Conclusions: We provided evidence of construct validity of the CMU-CBCRT, which could determine the CR skills of medical students at varying early stage in their careers. UR - https://games.jmir.org/2021/4/e17670 UR - http://dx.doi.org/10.2196/17670 UR - http://www.ncbi.nlm.nih.gov/pubmed/34751658 ID - info:doi/10.2196/17670 ER - TY - JOUR AU - Meuwly, Jean-Yves AU - Mandralis, Katerina AU - Tenisch, Estelle AU - Gullo, Giuseppe AU - Frossard, Pierre AU - Morend, Laura PY - 2021/11/1 TI - Use of an Online Ultrasound Simulator to Teach Basic Psychomotor Skills to Medical Students During the Initial COVID-19 Lockdown: Quality Control Study JO - JMIR Med Educ SP - e31132 VL - 7 IS - 4 KW - anatomy KW - computers in anatomical education KW - internet application in anatomy KW - medical education KW - ultrasonography KW - ultrasound KW - simulation KW - simulator KW - psychomotor KW - motor skills KW - medical students KW - teaching N2 - Background: Teaching medical ultrasound has increased in popularity in medical schools with hands-on workshops as an essential part of teaching. However, the lockdown due to COVID-19 kept medical schools from conducting these workshops. Objective: The aim of this paper is to describe an alternative method used by our medical school to allow our students to acquire the essential psychomotor skills to produce ultrasound images. Methods: Our students took online ultrasound courses. Consequently, they had to practice ultrasound exercises on a virtual simulator, using the mouse of their computer to control a simulated transducer. Our team measured the precision reached at the completion of simulation exercises. Before and after completion of the courses and simulator?s exercises, students had to complete a questionnaire dedicated to psychomotor skills. A general evaluation questionnaire was also submitted. Results: A total of 193 students returned the precourse questionnaire. A total of 184 performed all the simulator exercises and 181 answered the postcourse questionnaire. Of the 180 general evaluation questionnaires that were sent out, 136 (76%) were returned. The average precourse score was 4.23 (SD 2.14). After exercising, the average postcourse score was 6.36 (SD 1.82), with a significant improvement (P<.001). The postcourse score was related to the accuracy with which the simulator exercises were performed (Spearman rho 0.2664; P<.001). Nearly two-thirds (n=84, 62.6%) of the students said they enjoyed working on the simulator. A total of 79 (58.0%) students felt that they had achieved the course?s objective of reproducing ultrasound images. Inadequate connection speed had been a problem for 40.2% (n=54) of students. Conclusions: The integration of an online simulator for the practical learning of ultrasound in remote learning situations has allowed for substantial acquisitions in the psychomotor field of ultrasound diagnosis. Despite the absence of workshops, the students were able to learn and practice how to handle an ultrasound probe to reproduce standard images. This study enhances the value of online programs in medical education, even for practical skills. UR - https://mededu.jmir.org/2021/4/e31132 UR - http://dx.doi.org/10.2196/31132 UR - http://www.ncbi.nlm.nih.gov/pubmed/34723818 ID - info:doi/10.2196/31132 ER - TY - JOUR AU - Tahri Sqalli, Mohammed AU - Al-Thani, Dena AU - Elshazly, B. Mohamed AU - Al-Hijji, ?Mohammed PY - 2021/10/14 TI - Interpretation of a 12-Lead Electrocardiogram by Medical Students: Quantitative Eye-Tracking Approach JO - JMIR Med Educ SP - e26675 VL - 7 IS - 4 KW - eye tracking KW - electrocardiogram KW - ECG interpretation KW - medical education KW - human-computer interaction KW - medical student KW - eye KW - tracking KW - interpretation KW - ECG N2 - Background: Accurate interpretation of a 12-lead electrocardiogram (ECG) demands high levels of skill and expertise. Early training in medical school plays an important role in building the ECG interpretation skill. Thus, understanding how medical students perform the task of interpretation is important for improving this skill. Objective: We aimed to use eye tracking as a tool to research how eye fixation can be used to gain a deeper understanding of how medical students interpret ECGs. Methods: In total, 16 medical students were recruited to interpret 10 different ECGs each. Their eye movements were recorded using an eye tracker. Fixation heatmaps of where the students looked were generated from the collected data set. Statistical analysis was conducted on the fixation count and duration using the Mann-Whitney U test and the Kruskal-Wallis test. Results: The average percentage of correct interpretations was 55.63%, with an SD of 4.63%. After analyzing the average fixation duration, we found that medical students study the three lower leads (rhythm strips) the most using a top-down approach: lead II (mean=2727 ms, SD=456), followed by leads V1 (mean=1476 ms, SD=320) and V5 (mean=1301 ms, SD=236). We also found that medical students develop a personal system of interpretation that adapts to the nature and complexity of the diagnosis. In addition, we found that medical students consider some leads as their guiding point toward finding a hint leading to the correct interpretation. Conclusions: The use of eye tracking successfully provides a quantitative explanation of how medical students learn to interpret a 12-lead ECG. UR - https://mededu.jmir.org/2021/4/e26675 UR - http://dx.doi.org/10.2196/26675 UR - http://www.ncbi.nlm.nih.gov/pubmed/34647899 ID - info:doi/10.2196/26675 ER - TY - JOUR AU - Qua, Kelli AU - Yu, Fei AU - Patel, Tanha AU - Dave, Gaurav AU - Cornelius, Katherine AU - Pelfrey, M. Clara PY - 2021/9/29 TI - Scholarly Productivity Evaluation of KL2 Scholars Using Bibliometrics and Federal Follow-on Funding: Cross-Institution Study JO - J Med Internet Res SP - e29239 VL - 23 IS - 9 KW - bibliometrics KW - Clinical and Translational Science Award KW - KL2 KW - translational research KW - career development N2 - Background: Evaluating outcomes of the clinical and translational research (CTR) training of a Clinical and Translational Science Award (CTSA) hub (eg, the KL2 program) requires the selection of reliable, accessible, and standardized measures. As measures of scholarly success usually focus on publication output and extramural funding, CTSA hubs have started to use bibliometrics to evaluate the impact of their supported scholarly activities. However, the evaluation of KL2 programs across CTSAs is limited, and the use of bibliometrics and follow-on funding is minimal. Objective: This study seeks to evaluate scholarly productivity, impact, and collaboration using bibliometrics and federal follow-on funding of KL2 scholars from 3 CTSA hubs and to define and assess CTR training success indicators. Methods: The sample included KL2 scholars from 3 CTSA institutions (A-C). Bibliometric data for each scholar in the sample were collected from both SciVal and iCite, including scholarly productivity, citation impact, and research collaboration. Three federal follow-on funding measures (at the 5-year, 8-year, and overall time points) were collected internally and confirmed by examining a federal funding database. Both descriptive and inferential statistical analyses were computed using SPSS to assess the bibliometric and federal follow-on funding results. Results: A total of 143 KL2 scholars were included in the sample with relatively equal groups across the 3 CTSA institutions. The included KL2 scholars produced more publications and citation counts per year on average at the 8-year time point (3.75 publications and 26.44 citation counts) than the 5-year time point (3.4 publications vs 26.16 citation counts). Overall, the KL2 publications from all 3 institutions were cited twice as much as others in their fields based on the relative citation ratio. KL2 scholars published work with researchers from other US institutions over 2 times (5-year time point) or 3.5 times (8-year time point) more than others in their research fields. Within 5 years and 8 years postmatriculation, 44.1% (63/143) and 51.7% (74/143) of KL2 scholars achieved federal funding, respectively. The KL2-scholars of Institution C had a significantly higher citation rate per publication than the other institutions (P<.001). Institution A had a significantly lower rate of nationally field-weighted collaboration than did the other institutions (P<.001). Institution B scholars were more likely to have received federal funding than scholars at Institution A or C (P<.001). Conclusions: Multi-institutional data showed a high level of scholarly productivity, impact, collaboration, and federal follow-on funding achieved by KL2 scholars. This study provides insights on the use of bibliometric and federal follow-on funding data to evaluate CTR training success across institutions. CTSA KL2 programs and other CTR career training programs can benefit from these findings in terms of understanding metrics of career success and using that knowledge to develop highly targeted strategies to support early-stage career development of CTR investigators. UR - https://www.jmir.org/2021/9/e29239 UR - http://dx.doi.org/10.2196/29239 UR - http://www.ncbi.nlm.nih.gov/pubmed/34586077 ID - info:doi/10.2196/29239 ER - TY - JOUR AU - Maheu-Cadotte, Marc-André AU - Dubé, Véronique AU - Cossette, Sylvie AU - Lapierre, Alexandra AU - Fontaine, Guillaume AU - Deschênes, Marie-France AU - Lavoie, Patrick PY - 2021/8/19 TI - Involvement of End Users in the Development of Serious Games for Health Care Professions Education: Systematic Descriptive Review JO - JMIR Serious Games SP - e28650 VL - 9 IS - 3 KW - game-based learning KW - health professions education KW - participatory design KW - systematic review KW - user-centered design KW - serious games KW - game development KW - end users KW - education N2 - Background: On the basis of ethical and methodological arguments, numerous calls have been made to increase the involvement of end users in the development of serious games (SGs). Involving end users in the development process is considered a way to give them power and control over educational software that is designed for them. It can also help identify areas for improvement in the design of SGs and improve their efficacy in targeted learning outcomes. However, no recognized guidelines or frameworks exist to guide end users? involvement in SG development. Objective: The aim of this study is to describe how end users are involved in the development of SGs for health care professions education. Methods: We examined the literature presenting the development of 45 SGs that had reached the stage of efficacy evaluation in randomized trials. One author performed data extraction using an ad hoc form based on a design and development framework for SGs. Data were then coded and synthesized on the basis of similarities. The coding scheme was refined iteratively with the involvement of a second author. Results are presented using frequencies and percentages. Results: End users? involvement was mentioned in the development of 21 of 45 SGs. The number of end users involved ranged from 12 to 36. End users were often involved in answering specific concerns that arose during the SG design (n=6) or in testing a prototype (n=12). In many cases, researchers solicited input from end users regarding the goals to reach (n=10) or the functional esthetics of the SGs (n=7). Most researchers used self-reported questionnaires (n=7). Conclusions: Researchers mentioned end users? involvement in the development of less than half of the identified SGs, and this involvement was also poorly described. These findings represent significant limitations to evaluating the impact of the involvement of end users on the efficacy of SGs and in making recommendations regarding their involvement. UR - https://games.jmir.org/2021/3/e28650 UR - http://dx.doi.org/10.2196/28650 UR - http://www.ncbi.nlm.nih.gov/pubmed/34129514 ID - info:doi/10.2196/28650 ER - TY - JOUR AU - Li, Li AU - Liu, Xiaobin AU - Chen, Zeyuan AU - Wang, Liyuan AU - Lian, Xiaoli AU - Zou, Huiru PY - 2021/8/13 TI - The Application of a Case-Based Social Media?Assisted Teaching Method in Cariology Education?Comparative Study JO - J Med Internet Res SP - e29372 VL - 23 IS - 8 KW - social media KW - case-based learning KW - cariology KW - dental cavity preparation KW - college students N2 - Background: Current cariology education based on the traditional teaching method faces a lot of challenges. Meanwhile, the COVID-19 pandemic caused an unprecedented disruption in medical education and health care systems worldwide. Innovation in the teaching mode of cariology education is required to change the situation. Objective: The goal of the research was to evaluate the application effects of a case-based social media?assisted teaching method in cariology education. Methods: Dental students of class 2019 were enrolled into the experimental group, while students of class 2018 served as control. A case-based social media?assisted teaching method was used in the experimental group, which included preclass activity via social media, additional discussion and practice process record in class, and questions and answers on the platform after class. The traditional teaching method, which consisted of conventional preparation before class, traditional lectures and demonstrations followed by students practice in class, and questions and answers step after class, was used in the control group. The teaching materials were the same in both groups. At the end of the program, students from both groups took cavity preparation skill evaluation tests. Questionnaires were tested on the case-based social media?assisted teaching group students anonymously. All data were analyzed using SPSS statistical software (version 22.0, IBM Corp). Results: The mean student cavity preparation skill evaluation scores was 82.51 (SD 6.82) in the experimental group and 77.19 (SD 5.98) in the control group (P<.05). The questionnaire response rate was 100%. Of those, 94.3% (100/106) of the students recommended the case-based social media?assisted teaching method in cariology education. The majority of the participants agreed that it helped them memorize the theoretical knowledge of cariology, facilitated in-depth discussion, improved their enthusiasm and initiative in learning, and enhanced the relationship between teachers and students (104/106, 98.1%). They also recognized that the classroom atmosphere was active (94/106, 88.7%). Conclusions: The case-based social media?assisted teaching method was beneficial in terms of learning, as demonstrated by the statistically significant improvement of the cavity preparation skill evaluation scores and satisfaction from attending students. This method could be used to supplement the teaching of cariology. UR - https://www.jmir.org/2021/8/e29372 UR - http://dx.doi.org/10.2196/29372 UR - http://www.ncbi.nlm.nih.gov/pubmed/34397390 ID - info:doi/10.2196/29372 ER - TY - JOUR AU - Van Gaalen, J. A. E. AU - Jaarsma, C. A. D. AU - Georgiadis, R. J. PY - 2021/7/28 TI - Medical Students? Perceptions of Play and Learning: Qualitative Study With Focus Groups and Thematic Analysis JO - JMIR Serious Games SP - e25637 VL - 9 IS - 3 KW - gamification KW - serious games KW - game-based learning KW - medical education KW - computers KW - new technology KW - focus group KW - play KW - qualitative N2 - Background: In times where distance learning is becoming the norm, game-based learning (GBL) is increasingly applied to health profession education. Yet, decisions for if, when, how, and for whom GBL should be designed cannot be made on a solid empirical basis. Though the act of play seems to be intertwined with GBL, it is generally ignored in the current scientific literature. Objective: The objective of our study was to explore students? perceptions of play in leisure time and of GBL as part of a mechanistic, bottom-up approach towards evidence-informed design and implementation of GBL in health profession education. Methods: We conducted 6 focus group discussions with medical and dentistry students, which were analyzed using thematic analysis. Results: A total of 58 students participated. We identified 4 major themes based on the students? perception of play in leisure time and on the combination of play and learning. Our results indicate that, while play preferences were highly various in our health profession student cohort, pleasure was the common ground reported for playing. Crucially, play and the serious act of learning seemed paradoxical, indicating that the value and meaning of play are strongly context-dependent for students. Conclusions: Four key points can be constructed from our study. First, students play for pleasure. Perceptions of pleasure vary considerably among students. Second, students consider play as inefficient. Inefficiency will only be justified when it increases learning. Third, play should be balanced with the serious and only be used for difficult or tedious courses. Fourth, GBL activities should not be made compulsory for students. We provide practical implications and directions for future research. UR - https://games.jmir.org/2021/3/e25637 UR - http://dx.doi.org/10.2196/25637 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319237 ID - info:doi/10.2196/25637 ER - TY - JOUR AU - Miao, H. Julia PY - 2021/6/14 TI - Adapting Medical Education Initiatives Through Team-Based e-Learning, Telemedicine Objective Structured Clinical Exams, and Student-Led Community Outreach During the COVID-19 Pandemic JO - JMIR Med Educ SP - e26797 VL - 7 IS - 2 KW - medical education KW - COVID-19 KW - medical student KW - community service KW - telemedicine KW - telehealth KW - community outreach KW - peer teaching KW - student-led initiative KW - clinical assessment KW - adaptability KW - team-based learning UR - https://mededu.jmir.org/2021/2/e26797 UR - http://dx.doi.org/10.2196/26797 UR - http://www.ncbi.nlm.nih.gov/pubmed/34061763 ID - info:doi/10.2196/26797 ER - TY - JOUR AU - Jacklin, Simon AU - Maskrey, Neal AU - Chapman, Stephen PY - 2021/6/10 TI - Shared Decision-Making With a Virtual Patient in Medical Education: Mixed Methods Evaluation Study JO - JMIR Med Educ SP - e22745 VL - 7 IS - 2 KW - shared decision making KW - virtual patient KW - communication KW - medical education N2 - Background: Shared decision-making (SDM) is a process in which clinicians and patients work together to select tests, treatments, management, or support packages based on clinical evidence and the patient?s informed preferences. Similar to any skill, SDM requires practice to improve. Virtual patients (VPs) are simulations that allow one to practice a variety of clinical skills, including communication. VPs can be used to help professionals and students practice communication skills required to engage in SDM; however, this specific focus has not received much attention within the literature. A multiple-choice VP was developed to allow students the opportunity to practice SDM. To interact with the VP, users chose what they wanted to say to the VP by choosing from multiple predefined options, rather than typing in what they wanted to say. Objective: This study aims to evaluate a VP workshop for medical students aimed at developing the communication skills required for SDM. Methods: Preintervention and postintervention questionnaires were administered, followed by semistructured interviews. The questionnaires provided cohort-level data on the participants? views of the VP and helped to inform the interview guide; the interviews were used to explore some of the data from the questionnaire in more depth, including the participants? experience of using the VP. Results: The interviews and questionnaires suggested that the VP was enjoyable and easy to use. When the participants were asked to rank their priorities in both pre- and post-VP consultations, there was a change in the rank position of respecting patient choices, with the median rank changing from second to first. Owing to the small sample size, this was not analyzed for statistical significance. The VP allowed the participants to explore a consultation in a way that they could not with simulated or real patients, which may be part of the reason that the VP was suggested as a useful intervention for bridging from the early, theory-focused years of the curriculum to the more patient-focused ones later. Conclusions: The VP was well accepted by the participants. The multiple-choice system of interaction was reported to be both useful and restrictive. Future work should look at further developing the mode of interaction and explore whether the VP results in any changes in observed behavior or practice. UR - https://mededu.jmir.org/2021/2/e22745 UR - http://dx.doi.org/10.2196/22745 UR - http://www.ncbi.nlm.nih.gov/pubmed/34110299 ID - info:doi/10.2196/22745 ER - TY - JOUR AU - Plackett, Ruth AU - Kassianos, P. Angelos AU - Timmis, Jessica AU - Sheringham, Jessica AU - Schartau, Patricia AU - Kambouri, Maria PY - 2021/6/4 TI - Using Virtual Patients to Explore the Clinical Reasoning Skills of Medical Students: Mixed Methods Study JO - J Med Internet Res SP - e24723 VL - 23 IS - 6 KW - computer simulation KW - web-based patient simulation KW - computer-assisted instruction KW - educational technology KW - medical education KW - clinical decision support systems KW - clinical decision making KW - clinical reasoning KW - clinical skills KW - primary care KW - diagnosis N2 - Background: Improving clinical reasoning skills?the thought processes used by clinicians to formulate appropriate questions and diagnoses?is essential for reducing missed diagnostic opportunities. The electronic Clinical Reasoning Educational Simulation Tool (eCREST) was developed to improve the clinical reasoning of future physicians. A feasibility trial demonstrated acceptability and potential impacts; however, the processes by which students gathered data were unknown. Objective: This study aims to identify the data gathering patterns of final year medical students while using eCREST and how eCREST influences the patterns. Methods: A mixed methods design was used. A trial of eCREST across 3 UK medical schools (N=148) measured the potential effects of eCREST on data gathering. A qualitative think-aloud and semistructured interview study with 16 medical students from one medical school identified 3 data gathering strategies: Thorough, Focused, and Succinct. Some had no strategy. Reanalysis of the trial data identified the prevalence of data gathering patterns and compared patterns between the intervention and control groups. Patterns were identified based on 2 variables that were measured in a patient case 1 month after the intervention: the proportion of Essential information students identified and the proportion of irrelevant information gathered (Relevant). Those who scored in the top 3 quartiles for Essential but in the lowest quartile for Relevant displayed a Thorough pattern. Those who scored in the top 3 quartiles for Relevant but in the lowest quartile for Essential displayed a Succinct pattern. Those who scored in the top 3 quartiles on both variables displayed a Focused pattern. Those whose scores were in the lowest quartile on both variables displayed a Nonspecific pattern. Results: The trial results indicated that students in the intervention group were more thorough than those in the control groups when gathering data. The qualitative data identified data gathering strategies and the mechanisms by which eCREST influenced data gathering. Students reported that eCREST promoted thoroughness by prompting them to continuously reflect and allowing them to practice managing uncertainty. However, some found eCREST to be less useful, and they randomly gathered information. Reanalysis of the trial data revealed that the intervention group was significantly more likely to display a Thorough data gathering pattern than controls (21/78, 27% vs 6/70, 9%) and less likely to display a Succinct pattern (13/78, 17% vs 20/70, 29%; ?23=9.9; P=.02). Other patterns were similar across groups. Conclusions: Qualitative data suggested that students applied a range of data gathering strategies while using eCREST and that eCREST encouraged thoroughness by continuously prompting the students to reflect and manage their uncertainty. Trial data suggested that eCREST led students to demonstrate more Thorough data gathering patterns. Virtual patients that encourage thoroughness could help future physicians avoid missed diagnostic opportunities and enhance the delivery of clinical reasoning teaching. UR - https://www.jmir.org/2021/6/e24723 UR - http://dx.doi.org/10.2196/24723 UR - http://www.ncbi.nlm.nih.gov/pubmed/34085940 ID - info:doi/10.2196/24723 ER - TY - JOUR AU - Zimianiti, Ioanna AU - Thanaraaj, Vyshnavi AU - Watson, Francesca AU - Osibona, Oluwapelumi PY - 2021/6/1 TI - Medical Students Learning on the COVID-19 Front Line JO - JMIR Med Educ SP - e28264 VL - 7 IS - 2 KW - medical education KW - COVID-19 KW - frontline workers KW - medical student KW - viewpoint KW - perspective KW - infectious disease KW - experience KW - barrier KW - motivation UR - https://mededu.jmir.org/2021/2/e28264 UR - http://dx.doi.org/10.2196/28264 UR - http://www.ncbi.nlm.nih.gov/pubmed/34038377 ID - info:doi/10.2196/28264 ER - TY - JOUR AU - Balaji, Aanika AU - Clever, Lou Sarah PY - 2021/5/28 TI - Incorporating Medical Students Into Primary Care Telehealth Visits: Tutorial JO - JMIR Med Educ SP - e24300 VL - 7 IS - 2 KW - medical student KW - education KW - primary care KW - telehealth KW - video visits KW - internal medicine KW - medical education KW - teleconsultation KW - digital health KW - COVID-19 N2 - Background: The COVID-19 pandemic has brought about sweeping change in health care delivery, which has shifted from in-person consultations to a web-based format. Few medical schools provide web-based medicine or telemedicine training to their learners, though this is likely to be important for future medical practice. Objective: This tutorial communicates a framework for incorporating medical students into primary care telemedicine clinics. Methods: A third-year medical student and internal medicine attending physician from the Johns Hopkins University completed telemedicine clinic visits in April 2020 by using a variety of video platforms and via telephone calls. Results: Nine telemedicine visits were completed over 4 clinic days. Our patients were, on average, aged 68 years. The majority of patients were female (6/9, 67%), and most appointments were completed via a video platform (6/9, 67%). Additionally, our experience is summarized and describe (1) practical tips for how to prepare for a telehealth visit; (2) technology considerations; (3) recommendations for participation during a telehealth visit; (4) debriefing and feedback; (5) challenges to care; and (6) student, care provider, and patient reactions to telemedicine visits. Conclusions: Telemedicine clinics have been successfully used for managing patients with chronic conditions, those who have attended low-risk urgent care visits, and those with mental health concerns. Patients have reported high patient satisfaction scores for telemedicine visits, and the majority of patients are comfortable with having medical students as part of their care team. Moving forward, telemedicine will remain a popular method for receiving health care. This study has highlighted that medical students can successfully be integrated into telemedicine clinics and that they should be exposed to telehealth whenever possible prior to residency. UR - https://mededu.jmir.org/2021/2/e24300 UR - http://dx.doi.org/10.2196/24300 UR - http://www.ncbi.nlm.nih.gov/pubmed/33974552 ID - info:doi/10.2196/24300 ER - TY - JOUR AU - Said, Sadiq AU - Roche, Raoul Tadzio AU - Braun, Julia AU - Ganter, Thomas Micheal AU - Meybohm, Patrick AU - Herrmann, Johannes AU - Zacharowski, Kai AU - Raimann, Jürgen Florian AU - Piekarski, Florian AU - Rivas, Eva AU - López-Baamonde, Manuel AU - Spahn, R. Donat AU - Nöthiger, Beat Christoph AU - Tscholl, Werner David PY - 2021/5/3 TI - Effects of an Animated Blood Clot Technology (Visual Clot) on the Decision-Making of Users Inexperienced in Viscoelastic Testing: Multicenter Trial JO - J Med Internet Res SP - e27124 VL - 23 IS - 5 KW - avatar technology KW - coagulation management KW - hemostasis KW - intuitive design KW - rotational thromboelastometry KW - user-centered design KW - Visual Clot KW - testing N2 - Background: Viscoelastic test?guided coagulation management has become increasingly important in assessing hemostasis. We developed Visual Clot, an animated, 3D blood clot that illustrates raw rotational thromboelastometry (ROTEM) parameters in a user-centered and situation awareness?oriented method. Objective: This study aimed to evaluate the applicability of Visual Clot by examining its effects on users that are novices in viscoelastic-guided resuscitation. Methods: We conducted an investigator-initiated, international, multicenter study between September 16, 2020, and October 6, 2020, in 5 tertiary care hospitals in central Europe. We randomly recruited medical students and inexperienced resident physicians without significant prior exposure to viscoelastic testing. The 7 participants per center managed 9 different ROTEM outputs twice, once as standard ROTEM tracings and once as the corresponding Visual Clot. We randomly presented the 18 viscoelastic cases and asked the participants for their therapeutic decisions. We assessed the performance, diagnostic confidence, and perceived workload in managing the tasks using mixed statistical models and adjusted for possible confounding factors. Results: Analyzing a total of 630 results, we found that the participants solved more cases correctly (odds ratio [OR] 33.66, 95% CI 21.13-53.64; P<.001), exhibited more diagnostic confidence (OR 206.2, 95% CI 93.5-454.75; P<.001), and perceived less workload (coefficient ?41.63; 95% CI ?43.91 to ?39.36; P<.001) using Visual Clot compared to using standard ROTEM tracings. Conclusions: This study emphasizes the practical benefit of presenting viscoelastic test results in a user-centered way. Visual Clot may allow inexperienced users to be involved in the decision-making process to treat bleeding-associated coagulopathy. The increased diagnostic confidence, diagnostic certainty, reduced workload, and positive user feedback associated with this visualization may promote the further adoption of viscoelastic methods in diverse health care settings. UR - https://www.jmir.org/2021/5/e27124 UR - http://dx.doi.org/10.2196/27124 UR - http://www.ncbi.nlm.nih.gov/pubmed/33843602 ID - info:doi/10.2196/27124 ER - TY - JOUR AU - Gladman, Tehmina AU - Tylee, Grace AU - Gallagher, Steve AU - Mair, Jonathan AU - Grainger, Rebecca PY - 2021/4/23 TI - Measuring the Quality of Clinical Skills Mobile Apps for Student Learning: Systematic Search, Analysis, and Comparison of Two Measurement Scales JO - JMIR Mhealth Uhealth SP - e25377 VL - 9 IS - 4 KW - mobile apps KW - MARS KW - MARuL KW - medical education KW - app review KW - mobile phone N2 - Background: Mobile apps are widely used in health professions, which increases the need for simple methods to determine the quality of apps. In particular, teachers need the ability to curate high-quality mobile apps for student learning. Objective: This study aims to systematically search for and evaluate the quality of clinical skills mobile apps as learning tools. The quality of apps meeting the specified criteria was evaluated using two measures?the widely used Mobile App Rating Scale (MARS), which measures general app quality, and the Mobile App Rubric for Learning (MARuL), a recently developed instrument that measures the value of apps for student learning?to assess whether MARuL is more effective than MARS in identifying high-quality apps for learning. Methods: Two mobile app stores were systematically searched using clinical skills terms commonly found in medical education and apps meeting the criteria identified using an approach based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 9 apps were identified during the screening process. The apps were rated independently by 2 reviewers using MARS and MARuL. Results: The intraclass correlation coefficients (ICCs) for the 2 raters using MARS and MARuL were the same (MARS ICC [two-way]=0.68; P<.001 and MARuL ICC [two-way]=0.68; P<.001). Of the 9 apps, Geeky Medics-OSCE revision (MARS Android=3.74; MARS iOS=3.68; MARuL Android=75; and MARuL iOS=73) and OSCE PASS: Medical Revision (MARS Android=3.79; MARS iOS=3.71; MARuL Android=69; and MARuL iOS=73) scored highly on both measures of app quality and for both Android and iOS. Both measures also showed agreement for the lowest rated app, Patient Education Institute (MARS Android=2.21; MARS iOS=2.11; MARuL Android=18; and MARuL iOS=21.5), which had the lowest scores in all categories except information (MARS) and professional (MARuL) in both operating systems. MARS and MARuL were both able to differentiate between the highest and lowest quality apps; however, MARuL was better able to differentiate apps based on teaching and learning quality. Conclusions: This systematic search and rating of clinical skills apps for learning found that the quality of apps was highly variable. However, 2 apps?Geeky Medics-OSCE revision and OSCE PASS: Medical Revision?rated highly for both versions and with both quality measures. MARS and MARuL showed similar abilities to differentiate the quality of the 9 apps. However, MARuL?s incorporation of teaching and learning elements as part of a multidimensional measure of quality may make it more appropriate for use with apps focused on teaching and learning, whereas MARS?s more general rating of quality may be more appropriate for health apps targeting a general health audience. Ratings of the 9 apps by both measures also highlighted the variable quality of clinical skills mobile apps for learning. UR - https://mhealth.jmir.org/2021/4/e25377 UR - http://dx.doi.org/10.2196/25377 UR - http://www.ncbi.nlm.nih.gov/pubmed/33890859 ID - info:doi/10.2196/25377 ER - TY - JOUR AU - Wamsley, Maria AU - Cornejo, Laeesha AU - Kryzhanovskaya, Irina AU - Lin, W. Brian AU - Sullivan, Joseph AU - Yoder, Jordan AU - Ziv, Tali PY - 2021/4/21 TI - Best Practices for Integrating Medical Students Into Telehealth Visits JO - JMIR Med Educ SP - e27877 VL - 7 IS - 2 KW - telehealth KW - undergraduate medical education KW - workplace learning KW - ambulatory care KW - telehealth competencies KW - medical education KW - student education KW - digital learning KW - online learning KW - ambulatory KW - digital health UR - https://mededu.jmir.org/2021/2/e27877 UR - http://dx.doi.org/10.2196/27877 UR - http://www.ncbi.nlm.nih.gov/pubmed/33881407 ID - info:doi/10.2196/27877 ER - TY - JOUR AU - Furlan, Raffaello AU - Gatti, Mauro AU - Menè, Roberto AU - Shiffer, Dana AU - Marchiori, Chiara AU - Giaj Levra, Alessandro AU - Saturnino, Vincenzo AU - Brunetta, Enrico AU - Dipaola, Franca PY - 2021/4/9 TI - A Natural Language Processing?Based Virtual Patient Simulator and Intelligent Tutoring System for the Clinical Diagnostic Process: Simulator Development and Case Study JO - JMIR Med Inform SP - e24073 VL - 9 IS - 4 KW - COVID-19 KW - intelligent tutoring system KW - virtual patient simulator KW - natural language processing KW - artificial intelligence KW - clinical diagnostic reasoning N2 - Background: Shortage of human resources, increasing educational costs, and the need to keep social distances in response to the COVID-19 worldwide outbreak have prompted the necessity of clinical training methods designed for distance learning. Virtual patient simulators (VPSs) may partially meet these needs. Natural language processing (NLP) and intelligent tutoring systems (ITSs) may further enhance the educational impact of these simulators. Objective: The goal of this study was to develop a VPS for clinical diagnostic reasoning that integrates interaction in natural language and an ITS. We also aimed to provide preliminary results of a short-term learning test administered on undergraduate students after use of the simulator. Methods: We trained a Siamese long short-term memory network for anamnesis and NLP algorithms combined with Systematized Nomenclature of Medicine (SNOMED) ontology for diagnostic hypothesis generation. The ITS was structured on the concepts of knowledge, assessment, and learner models. To assess short-term learning changes, 15 undergraduate medical students underwent two identical tests, composed of multiple-choice questions, before and after performing a simulation by the virtual simulator. The test was made up of 22 questions; 11 of these were core questions that were specifically designed to evaluate clinical knowledge related to the simulated case. Results: We developed a VPS called Hepius that allows students to gather clinical information from the patient?s medical history, physical exam, and investigations and allows them to formulate a differential diagnosis by using natural language. Hepius is also an ITS that provides real-time step-by-step feedback to the student and suggests specific topics the student has to review to fill in potential knowledge gaps. Results from the short-term learning test showed an increase in both mean test score (P<.001) and mean score for core questions (P<.001) when comparing presimulation and postsimulation performance. Conclusions: By combining ITS and NLP technologies, Hepius may provide medical undergraduate students with a learning tool for training them in diagnostic reasoning. This may be particularly useful in a setting where students have restricted access to clinical wards, as is happening during the COVID-19 pandemic in many countries worldwide. UR - https://medinform.jmir.org/2021/4/e24073 UR - http://dx.doi.org/10.2196/24073 UR - http://www.ncbi.nlm.nih.gov/pubmed/33720840 ID - info:doi/10.2196/24073 ER - TY - JOUR AU - Liu, Qinlai AU - Sun, Wenping AU - Du, Changqing AU - Yang, Leiying AU - Yuan, Na AU - Cui, Haiqing AU - Song, Wengang AU - Ge, Li PY - 2021/3/15 TI - Medical Morphology Training Using the Xuexi Tong Platform During the COVID-19 Pandemic: Development and Validation of a Web-Based Teaching Approach JO - JMIR Med Inform SP - e24497 VL - 9 IS - 3 KW - COVID-19 KW - histology and embryology KW - pathology KW - web-based teaching KW - Xuexi Tong platform N2 - Background: Histology and Embryology and Pathology are two important basic medical morphology courses for studying human histological structures under healthy and pathological conditions, respectively. There is a natural succession between the two courses. At the beginning of 2020, the COVID-19 pandemic suddenly swept the world. During this unusual period, to ensure that medical students would understand and master basic medical knowledge and to lay a solid foundation for future medical bridge courses and professional courses, a web-based medical morphology teaching team, mainly including teachers of courses in Histology and Embryology and Pathology, was established. Objective: This study aimed to explore a new teaching mode of Histology and Embryology and Pathology courses during the COVID-19 pandemic and to illustrate its feasibility and acceptability. Methods: From March to July 2020, our team selected clinical medicine undergraduate students who started their studies in 2018 and 2019 as recipients of web-based teaching. Meanwhile, nursing undergraduate students who started their studies in 2019 and 2020 were selected for traditional offline teaching as the control group. For the web-based teaching, our team used the Xuexi Tong platform as the major platform to realize a new ?seven-in-one? teaching method (ie, videos, materials, chapter tests, interactions, homework, live broadcasts, and case analysis/discussion). This new teaching mode involved diverse web-based teaching methods and contents, including flipped classroom, screen-to-screen experimental teaching, a drawing competition, and a writing activity on the theme of ?What I Know About COVID-19.? When the teaching was about to end, a questionnaire was administered to obtain feedback regarding the teaching performance. In the meantime, the final written pathology examination results of the web-based teaching and traditional offline teaching groups were compared to examine the mastery of knowledge of the students. Results: Using the Xuexi Tong platform as the major platform to conduct ?seven-in-one? teaching is feasible and acceptable. With regard to the teaching performance of this new web-based teaching mode, students demonstrated a high degree of satisfaction, and the questionnaire showed that 71.3% or more of the students in different groups reported a greater degree of satisfaction or being very satisfied. In fact, more students achieved high scores (90-100) in the web-based learning group than in the offline learning control group (P=.02). Especially, the number of students with objective scores >60 in the web-based learning group was greater than that in the offline learning control group (P=.045). Conclusions: This study showed that the web-based teaching mode was not inferior to the traditional offline teaching mode for medical morphology courses, proving the feasibility and acceptability of web-based teaching during the COVID-19 pandemic. Our findings lay a solid theoretical foundation for follow-up studies of medical students. UR - https://medinform.jmir.org/2021/3/e24497 UR - http://dx.doi.org/10.2196/24497 UR - http://www.ncbi.nlm.nih.gov/pubmed/33566792 ID - info:doi/10.2196/24497 ER - TY - JOUR AU - Fink, C. Maximilian AU - Reitmeier, Victoria AU - Stadler, Matthias AU - Siebeck, Matthias AU - Fischer, Frank AU - Fischer, R. Martin PY - 2021/3/4 TI - Assessment of Diagnostic Competences With Standardized Patients Versus Virtual Patients: Experimental Study in the Context of History Taking JO - J Med Internet Res SP - e21196 VL - 23 IS - 3 KW - clinical reasoning KW - medical education KW - performance-based assessment KW - simulation KW - standardized patient KW - virtual patient N2 - Background: Standardized patients (SPs) have been one of the popular assessment methods in clinical teaching for decades, although they are resource intensive. Nowadays, simulated virtual patients (VPs) are increasingly used because they are permanently available and fully scalable to a large audience. However, empirical studies comparing the differential effects of these assessment methods are lacking. Similarly, the relationships between key variables associated with diagnostic competences (ie, diagnostic accuracy and evidence generation) in these assessment methods still require further research. Objective: The aim of this study is to compare perceived authenticity, cognitive load, and diagnostic competences in performance-based assessment using SPs and VPs. This study also aims to examine the relationships of perceived authenticity, cognitive load, and quality of evidence generation with diagnostic accuracy. Methods: We conducted an experimental study with 86 medical students (mean 26.03 years, SD 4.71) focusing on history taking in dyspnea cases. Participants solved three cases with SPs and three cases with VPs in this repeated measures study. After each case, students provided a diagnosis and rated perceived authenticity and cognitive load. The provided diagnosis was scored in terms of diagnostic accuracy; the questions asked by the medical students were rated with respect to their quality of evidence generation. In addition to regular null hypothesis testing, this study used equivalence testing to investigate the absence of meaningful effects. Results: Perceived authenticity (1-tailed t81=11.12; P<.001) was higher for SPs than for VPs. The correlation between diagnostic accuracy and perceived authenticity was very small (r=0.05) and neither equivalent (P=.09) nor statistically significant (P=.32). Cognitive load was equivalent in both assessment methods (t82=2.81; P=.003). Intrinsic cognitive load (1-tailed r=?0.30; P=.003) and extraneous load (1-tailed r=?0.29; P=.003) correlated negatively with the combined score for diagnostic accuracy. The quality of evidence generation was positively related to diagnostic accuracy for VPs (1-tailed r=0.38; P<.001); this finding did not hold for SPs (1-tailed r=0.05; P=.32). Comparing both assessment methods with each other, diagnostic accuracy was higher for SPs than for VPs (2-tailed t85=2.49; P=.01). Conclusions: The results on perceived authenticity demonstrate that learners experience SPs as more authentic than VPs. As higher amounts of intrinsic and extraneous cognitive loads are detrimental to performance, both types of cognitive load must be monitored and manipulated systematically in the assessment. Diagnostic accuracy was higher for SPs than for VPs, which could potentially negatively affect students? grades with VPs. We identify and discuss possible reasons for this performance difference between both assessment methods. UR - https://www.jmir.org/2021/3/e21196 UR - http://dx.doi.org/10.2196/21196 UR - http://www.ncbi.nlm.nih.gov/pubmed/33661122 ID - info:doi/10.2196/21196 ER - TY - JOUR AU - Guinez-Molinos, Sergio AU - Gonzalez Díaz, Jaime AU - Gomar Sancho, Carmen AU - Espinoza, Paulina AU - Constenla, Gustavo PY - 2021/1/26 TI - A Web Platform (MOSAICO) to Design, Perform, and Assess Collaborative Clinical Scenarios for Medical Students: Viewpoint JO - JMIR Med Educ SP - e23370 VL - 7 IS - 1 KW - collaborative clinical simulation KW - electronic simulation record KW - medical students KW - medical education KW - MOSAICO N2 - Background: The collaborative clinical simulation (CCS) model is a structured method for the development and assessment of clinical competencies through small groups working collaboratively in simulated environments. From 2016 onward, the CCS model has been applied successfully among undergraduate and graduate medical students from the Universidad de Talca, Chile; the Universität de Barcelona, Spain; and the Universidad de Vic-Manresa, Spain. All the templates for building the clinical cases and the assessment instruments with CCS were printed on paper. Considering the large number of CCS sessions and the number of participating students that are required throughout the medical degree curriculum, it is impossible to keep an organized record when the instruments are printed on paper. Moreover, with the COVID-19 pandemic, web platforms have become important as safe training environments for students and medical faculties; this new educational environment should include the consolidation and adaptation of didactic sessions that create and use available virtual cases and use different web platforms. Objective: The goal of this study is to describe the design and development of a web platform that was created to strengthen the CCS model. Methods: The design of the web platform aimed to support each phase of the CCS by incorporating functional requirements (ie, features that the web platform will be able to perform) and nonfunctional requirements (ie, how the web platform should behave) that are needed to run collaborative sessions. The software was developed under the Model-View-Controller architecture to separate the views from the data model and the business logic. Results: MOSAICO is a web platform used to design, perform, and assess collaborative clinical scenarios for medical students. MOSAICO has four modules: educational design, students? collaborative design, collaborative simulation, and collaborative debriefing. The web platform has three different user profiles: academic simulation unit, teacher, and student. These users interact under different roles in collaborative simulations. MOSAICO enables a collaborative environment, which is connected via the internet, to design clinical scenarios guided by the teacher and enables the use of all data generated to be discussed in the debriefing session with the teacher as a guide. The web platform is running at the Universidad de Talca in Chile and is supporting collaborative simulation activities via the internet for two medical courses: (1) Semiology for third-year students (70 students in total) and (2) Medical Genetics for fifth-year students (30 students in total). Conclusions: MOSAICO is applicable within the CCS model and is used frequently in different simulation sessions at the Universidad de Talca, where medical students can work collaboratively via the internet. MOSAICO simplifies the application and reuse of clinical simulation scenarios, allowing its use in multiple simulation centers. Moreover, its applications in different courses (ie, a large part of the medical curriculum) support the automatic tracking of simulation activities and their assessment. UR - http://mededu.jmir.org/2021/1/e23370/ UR - http://dx.doi.org/10.2196/23370 UR - http://www.ncbi.nlm.nih.gov/pubmed/33496676 ID - info:doi/10.2196/23370 ER - TY - JOUR AU - Suppan, Mélanie AU - Stuby, Loric AU - Carrera, Emmanuel AU - Cottet, Philippe AU - Koka, Avinash AU - Assal, Frédéric AU - Savoldelli, Louis Georges AU - Suppan, Laurent PY - 2021/1/15 TI - Asynchronous Distance Learning of the National Institutes of Health Stroke Scale During the COVID-19 Pandemic (E-Learning vs Video): Randomized Controlled Trial JO - J Med Internet Res SP - e23594 VL - 23 IS - 1 KW - stroke KW - COVID-19 KW - e-learning KW - medical student KW - medical education KW - online learning KW - randomized controlled trial KW - video N2 - Background: The COVID-19 pandemic has considerably altered the regular medical education curriculum while increasing the need for health care professionals. Senior medical students are being incrementally deployed to the front line to address the shortage of certified physicians. These students, some of whom will be fast-tracked as physicians, may lack knowledge regarding the initial management of time-critical emergencies such as stroke. Objective: Our aim was to determine whether an e-learning module could improve asynchronous distance knowledge acquisition of the National Institutes of Health Stroke Scale (NIHSS) in senior medical students compared to the traditional didactic video. Methods: A randomized, data analyst?blinded web-based trial was conducted at the University of Geneva Faculty of Medicine between April and June 2020. Fifth year medical students followed a distance learning path designed to teach the NIHSS. The control group followed the traditional didactic video created by Patrick Lyden, while the e-learning group followed the updated version of a previously tested, highly interactive e-learning module. The main outcome was the score on a 50-question quiz displayed upon completion of the learning material. The difference in the proportion of correct answers for each specific NIHSS item was also assessed. Results: Out of 158 potential participants, 88 started their allocated learning path and 75 completed the trial. Participants who followed the e-learning module performed better than those who followed the video (38 correct answers, 95% CI 37-39, vs 35 correct answers, 95% CI 34-36, P<.001). Participants in the e-learning group scored better on five elements than the video group: key NIHSS concepts (P=.02), the consciousness ? global item (P<.001), the facial palsy item (P=.04), the ataxia item (P=.03), and the sensory item (P=.04). Conclusions: Compared to the traditional didactic video, a highly interactive e-learning module enhances asynchronous distance learning and NIHSS knowledge acquisition in senior medical students. UR - http://www.jmir.org/2021/1/e23594/ UR - http://dx.doi.org/10.2196/23594 UR - http://www.ncbi.nlm.nih.gov/pubmed/33428581 ID - info:doi/10.2196/23594 ER - TY - JOUR AU - Björn, Henrik Marko AU - Laurila, MM Jonne AU - Ravyse, Werner AU - Kukkonen, Jari AU - Leivo, Sanna AU - Mäkitalo, Kati AU - Keinonen, Tuula PY - 2020/12/30 TI - Learning Impact of a Virtual Brain Electrical Activity Simulator Among Neurophysiology Students: Mixed-Methods Intervention Study JO - JMIR Serious Games SP - e18768 VL - 8 IS - 4 KW - virtual simulation KW - electroencephalography KW - theoretical knowledge KW - neurophysiology KW - brain activity KW - psychomotor N2 - Background: Virtual simulation is the re-creation of reality depicted on a computer screen. It offers the possibility to exercise motor and psychomotor skills. In biomedical and medical education, there is an attempt to find new ways to support students? learning in neurophysiology. Traditionally, recording electroencephalography (EEG) has been learned through practical hands-on exercises. To date, virtual simulations of EEG measurements have not been used. Objective: This study aimed to examine the development of students? theoretical knowledge and practical skills in the EEG measurement when using a virtual EEG simulator in biomedical laboratory science in the context of a neurophysiology course. Methods: A computer-based EEG simulator was created. The simulator allowed virtual electrode placement and EEG graph interpretation. The usefulness of the simulator for learning EEG measurement was tested with 35 participants randomly divided into three equal groups. Group 1 (experimental group 1) used the simulator with fuzzy feedback, group 2 (experimental group 2) used the simulator with exact feedback, and group 3 (control group) did not use a simulator. The study comprised pre- and posttests on theoretical knowledge and practical hands-on evaluation of EEG electrode placement. Results: The Wilcoxon signed-rank test indicated that the two groups that utilized a computer-based electrode placement simulator showed significant improvement in both theoretical knowledge (Z=1.79, P=.074) and observed practical skills compared with the group that studied without a simulator. Conclusions: Learning electrode placement using a simulator enhances students? ability to place electrodes and, in combination with practical hands-on training, increases their understanding of EEG measurement. UR - http://games.jmir.org/2020/4/e18768/ UR - http://dx.doi.org/10.2196/18768 UR - http://www.ncbi.nlm.nih.gov/pubmed/33377872 ID - info:doi/10.2196/18768 ER - TY - JOUR AU - Carson, Y. Thaddeus AU - Hatzigeorgiou, Christos AU - Wyatt, R. Tasha AU - Egan, Sarah AU - Beidas, O. Sary PY - 2020/12/29 TI - Development and Implementation of a Web-Based Learning Environment for an Inpatient Internal Medicine Team: Questionnaire Study JO - JMIR Med Educ SP - e18102 VL - 6 IS - 2 KW - inpatient internal medicine KW - academic hospitalist KW - medical education KW - blended learning environment KW - social media KW - online education KW - internal medicine ward KW - internal medicine education N2 - Background: The notion of anytime, anyplace communication is characteristic of the current generation of learners. Such communications have facilitated the growth and integration of a blended or hybrid learning platform in multiple educational settings. However, there are limited reports on the use of an anytime, anyplace communication platform in clinical inpatient medical education. Objective: The setting of a high-demand inpatient clinical rotation is ideal for the use of collaborative software, and this integration is expected to positively influence medical education. The purpose of this study is to evaluate medical students? and residents? educational experiences with incorporating a simple, web-based content management and file sharing platform into an internal medicine inpatient rotation. Methods: During an inpatient internal medicine rotation, faculty and learners jointly used collaborative software for educational purposes, and a postrotation survey tool was used to measure the educational influence of the software. Results: Based on the results of the postrotation survey, the integration of a collaborative software application during clinical rotations improved the learning experience. Learning climate, the communication of rotation goals, and self-directed learning all scored favorably, but feedback from the survey participants was mixed. The learners enthusiastically accepted the practical use of this tool for both communication and information sharing. Conclusions: This generation of learners is accustomed to frequent electronic communication. Based on our survey, these learners appear to be highly receptive to this web-based intervention design for improving clinical education during active patient care. Adding effective blended learning features to a traditional clinical setting is achievable. UR - http://mededu.jmir.org/2020/2/e18102/ UR - http://dx.doi.org/10.2196/18102 UR - http://www.ncbi.nlm.nih.gov/pubmed/33372895 ID - info:doi/10.2196/18102 ER - TY - JOUR AU - Tong, Ka Anson Hei AU - See, Christopher PY - 2020/11/23 TI - Informal and Formal Peer Teaching in the Medical School Ecosystem: Perspectives From a Student-Teacher Team JO - JMIR Med Educ SP - e21869 VL - 6 IS - 2 KW - Peer learning KW - medical education KW - peer teaching KW - peer-led learning KW - peer KW - education UR - http://mededu.jmir.org/2020/2/e21869/ UR - http://dx.doi.org/10.2196/21869 UR - http://www.ncbi.nlm.nih.gov/pubmed/33226345 ID - info:doi/10.2196/21869 ER - TY - JOUR AU - Naidoo, Nerissa AU - Akhras, Aya AU - Banerjee, Yajnavalka PY - 2020/10/7 TI - Confronting the Challenges of Anatomy Education in a Competency-Based Medical Curriculum During Normal and Unprecedented Times (COVID-19 Pandemic): Pedagogical Framework Development and Implementation JO - JMIR Med Educ SP - e21701 VL - 6 IS - 2 KW - undergraduate medical education KW - anatomy education KW - Gagne?s 9 events of instruction KW - Peyton?s 4-step approach KW - Mento?s 12-step change management model KW - Bourdieu?s Theory of Practice KW - social media application KW - interactome KW - COVID-19 KW - framework N2 - Background: Anatomy is considered to be one of the keystones of undergraduate medical education. However, recently, there has been drastic reduction, both in gross anatomy teaching hours and its context. Additionally, a decrease in the number of trained anatomists and an increase in the costs associated with procuring human cadavers have been noted, causing a diminution of cadaveric dissections in anatomy education. Objective: To address these challenges, there is an ardent need for a pedagogical framework such that anatomy education can be disseminated through active learning principles, within a fixed time frame, using a small team of anatomists and a small number of cadaveric specimens (for live on-site sessions) as well as collaborative learning principles. The latter is particularly important when anatomy education is delivered through distance learning, as is the case currently during the COVID-19 pandemic. Methods: Here, we have blueprinted a pedagogical framework blending the instructional design models of Gagne?s 9 events of instruction with Peyton?s 4-step approach. The framework?s applicability was validated through the delivery of anatomical concepts, using an exemplar from the structure-function course Head and Neck during the normal and COVID-19?mandated lockdown periods, employing the archetype of Frey syndrome. Preliminary evaluation of the framework was pursued using student feedback and end-of-course feedback responses. The efficiency of the framework in knowledge transfer was also appraised. Results: The blueprinted instructional plan designed to implement the pedagogical framework was successfully executed in the dissemination of anatomy education, employing a limited number of cadaveric specimens (during normal times) and a social media application (SMA)?integrated ?interactome? strategy (during the COVID-19 lockdown). Students? response to the framework was positive. However, reluctance was expressed by a majority of the faculty in adopting the framework for anatomy education. To address this aspect, a strategy has been designed using Mento?s 12-step change management model. The long-term benefits for any medical school to adopt the blended pedagogical framework have also been explicated by applying Bourdieu?s Theory of Practice. Additionally, through the design of an SMA interactome model, the framework?s applicability to the delivery of anatomy education and content during the ongoing COVID-19 pandemic was realized. Conclusions: In conclusion, the study effectively tackles some of the contemporary key challenges associated with the delivery of anatomy content in medical education during normal and unprecedented times. UR - http://mededu.jmir.org/2020/2/e21701/ UR - http://dx.doi.org/10.2196/21701 UR - http://www.ncbi.nlm.nih.gov/pubmed/32873536 ID - info:doi/10.2196/21701 ER - TY - JOUR AU - Gladman, Tehmina AU - Tylee, Grace AU - Gallagher, Steve AU - Mair, Jonathan AU - Rennie, C. Sarah AU - Grainger, Rebecca PY - 2020/7/31 TI - A Tool for Rating the Value of Health Education Mobile Apps to Enhance Student Learning (MARuL): Development and Usability Study JO - JMIR Mhealth Uhealth SP - e18015 VL - 8 IS - 7 KW - questionnaire design KW - medical education KW - health occupations students KW - just-in-time learning KW - self-directed learning KW - mobile phone KW - rubric KW - mobile learning KW - mobile apps KW - mhealth KW - digital learning N2 - Background: To realize the potential for mobile learning in clinical skills acquisition, medical students and their teachers should be able to evaluate the value of an app to support student learning of clinical skills. To our knowledge, there is currently no rubric for evaluation of quality or value that is specific for apps to support medical student learning. Such a rubric might assist students to be more confident in using apps to support their learning. Objective: The objective of this study was to develop an instrument that can be used by health professional educators to rate the value of a mobile app to support health professional student learning. Methods: Using the literature, we developed a list of potential criteria for the evaluation of educational app value, which were then refined with a student group using a modified nominal group technique. The refined list was organized into themes, and the initial rubric, Mobile App Rubric for Learning (MARuL, version 1), was developed. iOS and Android app stores were searched for clinical skills apps that met our inclusion criteria. After the 2 reviewers were trained and the item descriptions were refined (version 2), a random sample of 10 included apps, 5 for each mobile operating system, was reviewed. Interitem and interrater analyses and discussions with the reviewers resulted in refinement of MARuL to version 3. The reviewers completed a review of 41 clinical skills mobile apps, and a second round of interitem and interrater reliability testing was performed, leading to version 4 of the MARuL. Results: Students identified 28 items (from an initial set of 144 possible items) during the nominal group phase, and these were then grouped into 4 themes: teaching and learning, user centered, professional, and usability. Testing and refinement with reviewers reduced the list to 26 items. Internal consistency for MARuL was excellent (?=.96), and the interrater reliability as measured by the intraclass correlation coefficient (ICC) was good (ICC=0.66). Conclusions: MARuL offers a fast and user-friendly method for teachers to select valuable apps to enhance student learning. UR - https://mhealth.jmir.org/2020/7/e18015 UR - http://dx.doi.org/10.2196/18015 UR - http://www.ncbi.nlm.nih.gov/pubmed/32735228 ID - info:doi/10.2196/18015 ER - TY - JOUR AU - Buijs-Spanjers, R. Kiki AU - Hegge, HM Harianne AU - Cnossen, Fokie AU - Jaarsma, ADC Debbie AU - de Rooij, E. Sophia PY - 2020/7/29 TI - Reasons to Engage in and Learning Experiences From Different Play Strategies in a Web-Based Serious Game on Delirium for Medical Students: Mixed Methods Design JO - JMIR Serious Games SP - e18479 VL - 8 IS - 3 KW - dark play KW - serious games KW - medical education KW - medical students KW - delirium N2 - Background: Although many studies have recently been published on the value of serious games for medical education, little attention has been given to the role of dark play (choosing unacceptable actions in games). Objective: This study aimed to investigate potential differences in the characteristics of medical students who have the opportunity to choose normal or dark play in a serious game. This study also aimed to compare their reasons for choosing a play strategy and their perceptions of what they learned from their game play. Methods: We asked undergraduate medical students to play a serious game in which they had to take care of a patient with delirium (The Delirium Experience). After getting acquainted with the game, students could opt for normal or dark play. Student characteristics (age, gender, experience with caring for older or delirious patients, and number of completed clerkships) were collected, and the Delirium Attitude Scale and Learning Motivation and Engagement Questionnaire were administered. Reasons for choosing normal or dark play were evaluated with an open-ended question. Information on lessons they had learned from the game was collected using an open-ended question and self-reported knowledge on delirium. Results: This study had 160 participants (89 normal play, 71 dark play). Male students (26/160, 56.5%) chose dark play significantly more often than female students (45/160, 39.5%; P=.049). We did not find significant differences in student characteristics or measurement outcomes between play strategies. Participants? main reason for choosing normal play was to learn how to provide care to delirious patients, and the main reason for dark play was to gain insight into what a delirious patient has to endure during delirious episodes. All participants learned what to do when taking care of a delirious patient and gained insight into how a patient experiences delirium. We found no differences in self-reported knowledge. Conclusions: When medical students have the opportunity to choose dark play in a serious game, half of them will probably choose this play strategy. Male students will more likely opt for dark play than female students. Choice of play strategy is not affected by any other student characteristic or measurement outcome. All students learned the same lessons from playing the game, irrespective of their learning strategy. UR - http://games.jmir.org/2020/3/e18479/ UR - http://dx.doi.org/10.2196/18479 UR - http://www.ncbi.nlm.nih.gov/pubmed/32723710 ID - info:doi/10.2196/18479 ER - TY - JOUR AU - Iancu, Magen Ariella AU - Kemp, Thomas Michael AU - Alam, Badre Hasan PY - 2020/7/20 TI - Unmuting Medical Students? Education: Utilizing Telemedicine During the COVID-19 Pandemic and Beyond JO - J Med Internet Res SP - e19667 VL - 22 IS - 7 KW - telemedicine KW - medical education KW - medical school KW - COVID-19 KW - education, medical, undergraduate KW - curriculum UR - http://www.jmir.org/2020/7/e19667/ UR - http://dx.doi.org/10.2196/19667 UR - http://www.ncbi.nlm.nih.gov/pubmed/32614776 ID - info:doi/10.2196/19667 ER - TY - JOUR AU - Torous, John AU - Nakamura, Zev AU - Rosen, Jordan AU - Ho, Pochu AU - Pelic, Christine AU - Kao, Elderon Larkin AU - Kasick, David AU - Witowsky, Joseph AU - Meyer, Fremonta PY - 2020/7/6 TI - Medical Student Utilization of a Novel Web-Based Platform (Psy-Q) for Question-Based Learning in Psychiatry: Pilot Questionnaire Study JO - JMIR Med Educ SP - e18340 VL - 6 IS - 2 KW - medical students KW - education KW - psychiatry N2 - Background: Medical students are turning to new and expanding web-based resources for learning during their psychiatry clerkships; however, there have not been concomitant efforts by educators to utilize web-based tools to promote innovative teaching. Objective: Utilizing a free learning platform (Psy-Q) created by our team, we sought to explore how digital technology may engage medical student learners, promote colearning between educators and medical students, and support sustainability of web-based platforms through crowdsourcing. Methods: Between 2017 and 2019, seven medical schools offered access to the platform during medical students? psychiatry clerkships. Use of the web-based platform was voluntary and not monitored or related to clerkship evaluation. Medical students completed a paper and pencil assessment of the platform at the end of their clerkship. Anonymous and aggregated website use data were gathered in accordance with institutional review board approval. Results: A total of 203 medical students across seven distinct psychiatry clerkships completed the survey. Of these students, 123 (60.6%) reported using the platform and reported accessing a mean of 45 questions. The most common device used to access the platform was a laptop and the second most common was a smartphone. The most common location to access the platform was home and the second most common was the hospital. Although few students contributed new questions, website utilization data suggested that all rated the quality and difficulty of the questions. Higher quality questions were medical students? main suggestion for further improvement. Conclusions: Our results suggest the feasibility and potential of educator- and learner-created web-based platforms to augment psychiatry education and develop relevant accessible resources in the digital sphere. Future work should focus on measuring objective educational outcomes of question taking and writing, as well as optimizing technology and exploring sustainable trainee-faculty partnership models for the creation and curation of content. UR - https://mededu.jmir.org/2020/2/e18340 UR - http://dx.doi.org/10.2196/18340 UR - http://www.ncbi.nlm.nih.gov/pubmed/32628114 ID - info:doi/10.2196/18340 ER - TY - JOUR AU - Yacob, Michael AU - Lotfi, Shamim AU - Tang, Shannon AU - Jetty, Prasad PY - 2020/6/19 TI - Wikipedia in Vascular Surgery Medical Education: Comparative Study JO - JMIR Med Educ SP - e18076 VL - 6 IS - 1 KW - medical education KW - Wikipedia KW - vascular surgery KW - medical student N2 - Background: Medical students commonly refer to Wikipedia as their preferred online resource for medical information. The quality and readability of articles about common vascular disorders on Wikipedia has not been evaluated or compared against a standard textbook of surgery. Objective: The aims of this study were to (1) compare the quality of Wikipedia articles to that of equivalent chapters in a standard undergraduate medical textbook of surgery, (2) identify any errors of omission in either resource, and (3) compare the readability of both resources using validated ease-of-reading and grade-level tools. Methods: Using the Medical Council of Canada Objectives for the Qualifying Examination, 8 fundamental topics of vascular surgery were chosen. The articles were found on Wikipedia using Wikipedia?s native search engine. The equivalent chapters were identified in Schwartz Principles of Surgery (ninth edition). Medical learners (n=2) assessed each of the texts on their original platforms to independently evaluate readability, quality, and errors of omission. Readability was evaluated with Flesch Reading Ease scores and 5 grade-level scores (Flesch-Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook Index, and Automated Readability Index), quality was evaluated using the DISCERN instrument, and errors of omission were evaluated using a standardized scoring system that was designed by the authors. Results: Flesch Reading Ease scores suggested that Wikipedia (mean 30.5; SD 8.4) was significantly easier to read (P=.03) than Schwartz (mean 20.2; SD 9.0). The mean grade level (calculated using all grade-level indices) of the Wikipedia articles (mean 14.2; SD 1.3) was significantly different (P=.02) than the mean grade level of Schwartz (mean 15.9; SD 1.4). The quality of the text was also assessed using the DISCERN instrument and suggested that Schwartz (mean 71.4; SD 3.1) had a significantly higher quality (P=.002) compared to that of Wikipedia (mean 52.9; SD 11.4). Finally, the Wikipedia error of omission rate (mean 12.5; SD 6.8) was higher than that of Schwartz (mean 21.3; SD 1.9) indicating that there were significantly fewer errors of omission in the surgical textbook (P=.008). Conclusions: Online resources are increasingly easier to access but can vary in quality. Based on this comparison, the authors of this study recommend the use of vascular surgery textbooks as a primary source of learning material because the information within is more consistent in quality and has fewer errors of omission. Wikipedia can be a useful resource for quick reference, particularly because of its ease of reading, but its vascular surgery articles require further development. UR - http://mededu.jmir.org/2020/1/e18076/ UR - http://dx.doi.org/10.2196/18076 UR - http://www.ncbi.nlm.nih.gov/pubmed/32417754 ID - info:doi/10.2196/18076 ER - TY - JOUR AU - Lander, Lina AU - Baxter, L. Sally AU - Cochran, L. Gary AU - Gali, E. Helena AU - Cook, Kristen AU - Hatch, Thomas AU - Taylor, Regan AU - Awdishu, Linda PY - 2020/6/12 TI - Self-Perceptions of Readiness to Use Electronic Health Records Among Medical Students: Survey Study JO - JMIR Med Educ SP - e17585 VL - 6 IS - 1 KW - electronic health record KW - medical student KW - education KW - training KW - residency N2 - Background: Although several national organizations have declared the ability to work with electronic health records (EHRs) as a core competency of medical education, EHR education and use among medical students vary widely. Previous studies have reported EHR tasks performed by medical students, but students? self-perceived readiness and comfort with EHRs are relatively unknown. Objective: This study aimed to better understand medical students? self-perceived readiness to use EHRs to identify potential curricular gaps and inform future training efforts based on students? perspectives. Methods: The authors deployed a survey investigating self-perceived comfort with EHRs at 2 institutions in the United States in May 2019. Descriptive statistics were generated regarding demographics, comfort level with various EHR-related tasks, and cross-institutional comparisons. We also assessed the impact of extracurricular EHR experience on comfort level. Results: In total, 147 medical students responded, of which 80 (54.4%) were female, with equal distribution across all 4 years of training. Overall confidence was generally higher for students with longer extracurricular EHR experience, even when adjusted for age, gender, year of training, and institution. Students were most comfortable with tasks related to looking up information in the EHR and felt less comfortable with tasks related to entering new information and managing medications. Fourth-year students at both schools reported similar levels of comfort with EHR use, despite differences in preclinical EHR training. Open-ended comments emphasized the value of experiential training over didactic formats. Conclusions: Information entry and medication management in the EHR represent areas for future curricular development. Experiential training via extracurricular activities and early clinical exposure may be high-yield approaches to help medical students achieve critical EHR competencies. UR - http://mededu.jmir.org/2020/1/e17585/ UR - http://dx.doi.org/10.2196/17585 UR - http://www.ncbi.nlm.nih.gov/pubmed/32442135 ID - info:doi/10.2196/17585 ER - TY - JOUR AU - Zamberg, Ido AU - Windisch, Olivier AU - Agoritsas, Thomas AU - Nendaz, Mathieu AU - Savoldelli, Georges AU - Schiffer, Eduardo PY - 2020/5/27 TI - A Mobile Medical Knowledge Dissemination Platform (HeadToToe): Mixed Methods Study JO - JMIR Med Educ SP - e17729 VL - 6 IS - 1 KW - clinical skills KW - clinical competence KW - clinical practice guidelines KW - medical education KW - smartphone KW - innovation KW - medical guidance KW - mobile phone N2 - Background: Finding readily accessible, high-quality medical references can be a challenging task. HeadToToe is a mobile platform designed to allow easy and quick access to sound, up-to-date, and validated medical knowledge and guidance. It provides easy access to essential clinical medical content in the form of documents, videos, clinical scores, and other formats for the day-to-day access and use by medical students and physicians during their pre- and postgraduate education. Objective: The aim of this paper is to describe the architecture, user interface, and potential strengths and limitations of an innovative knowledge dissemination platform developed at the University of Geneva, Switzerland. We also report preliminary results from a user-experience survey and usage statistics over a selected period. Methods: The dissemination platform consists of a smartphone app. Through an administration interface, content is managed by senior university and hospital staff. The app includes the following sections: (1) main section of medical guidance, organized by clinical field; (2) checklists for history-taking and clinical examination, organized by body systems; (3) laboratory section with frequently used lab values; and (4) favorites section. Each content item is programmed to be available for a given duration as defined by the content?s author. Automatic notifications signal the author when the content is about to expire, hence, promoting its timely updating and reducing the risk of using obsolete content. In the background, a third-party statistical collecting tool records anonymous utilization statistics. Results: We launched the final version of the platform in March 2019, both at the Faculty of Medicine at the University of Geneva and at the University Hospital of Geneva in Switzerland. A total of 622 students at the university and 613 health professionals at the hospital downloaded the app. Two-thirds of users at both institutions had an iOS device. During the practical examination period (ie, May 2019) there was a significant increase in the number of active users (P=.003), user activity (P<.001), and daily usage time (P<.001) among medical students. In addition, there were 1086 clinical skills video views during this period compared to a total of 484 in the preceding months (ie, a 108% increase). On a 10-point Likert scale, students and physicians rated the app with mean scores of 8.2 (SD 1.9) for user experience, 8.1 (SD 2.0) for usefulness, and 8.5 (SD 1.8) for relevance of content. In parallel, postgraduate trainees viewed more than 6000 documents during the first 3 months after the implementation in the Division of Neurology at our institution. Conclusions: HeadToToe is an educator-driven, mobile dissemination platform, which provides rapid and user-friendly access to up-to-date medical content and guidance. The platform was given high ratings for user experience, usefulness, and content quality and was used more often during the exam period. This suggests that the platform could be used as tool for exam preparation. UR - http://mededu.jmir.org/2020/1/e17729/ UR - http://dx.doi.org/10.2196/17729 UR - http://www.ncbi.nlm.nih.gov/pubmed/32249758 ID - info:doi/10.2196/17729 ER - TY - JOUR AU - Setrakian, Jean AU - Gauthier, Geneviève AU - Bergeron, Linda AU - Chamberland, Martine AU - St-Onge, Christina PY - 2020/3/12 TI - Comparison of Assessment by a Virtual Patient and by Clinician-Educators of Medical Students' History-Taking Skills: Exploratory Descriptive Study JO - JMIR Med Educ SP - e14428 VL - 6 IS - 1 KW - virtual patients KW - medical history taking KW - automated scoring KW - simulation training KW - medical education KW - medical students KW - educational assessment KW - computer software KW - medical history?taking skills KW - medical history?taking skills assessment N2 - Background: A virtual patient (VP) can be a useful tool to foster the development of medical history?taking skills without the inherent constraints of the bedside setting. Although VPs hold the promise of contributing to the development of students? skills, documenting and assessing skills acquired through a VP is a challenge. Objective: We propose a framework for the automated assessment of medical history taking within a VP software and then test this framework by comparing VP scores with the judgment of 10 clinician-educators (CEs). Methods: We built upon 4 domains of medical history taking to be assessed (breadth, depth, logical sequence, and interviewing technique), adapting these to be implemented into a specific VP environment. A total of 10 CEs watched the screen recordings of 3 students to assess their performance first globally and then for each of the 4 domains. Results: The scores provided by the VPs were slightly higher but comparable with those given by the CEs for global performance and for depth, logical sequence, and interviewing technique. For breadth, the VP scores were higher for 2 of the 3 students compared with the CE scores. Conclusions: Findings suggest that the VP assessment gives results akin to those that would be generated by CEs. Developing a model for what constitutes good history-taking performance in specific contexts may provide insights into how CEs generally think about assessment. UR - http://mededu.jmir.org/2020/1/e14428/ UR - http://dx.doi.org/10.2196/14428 UR - http://www.ncbi.nlm.nih.gov/pubmed/32163036 ID - info:doi/10.2196/14428 ER - TY - JOUR AU - Lozano-Lozano, Mario AU - Galiano-Castillo, Noelia AU - Fernández-Lao, Carolina AU - Postigo-Martin, Paula AU - Álvarez-Salvago, Francisco AU - Arroyo-Morales, Manuel AU - Cantarero-Villanueva, Irene PY - 2020/3/10 TI - The Ecofisio Mobile App for Assessment and Diagnosis Using Ultrasound Imaging for Undergraduate Health Science Students: Multicenter Randomized Controlled Trial JO - J Med Internet Res SP - e16258 VL - 22 IS - 3 KW - undergraduate KW - OSCE KW - mHealth KW - teaching and learning strategies N2 - Background: Generation Z is starting to reach college age. They have adopted technology from an early age and have a deep dependence on it; therefore, they have become more drawn to the virtual world. M-learning has experienced huge growth in recent years, both in the medical context and in medical and health sciences education. Ultrasound imaging is an important diagnosis technique in physiotherapy, especially in sports pathology. M-learning systems could be useful tools for improving the comprehension of ultrasound concepts and the acquisition of professional competencies. Objective: The purpose of this study was to evaluate the efficacy and use of an interactive platform accessible through mobile devices?Ecofisio?using ultrasound imaging for the development of professional competencies in the evaluation and diagnosis of sports pathologies. Methods: Participants included 110 undergraduate students who were placed into one of two groups of a randomized controlled multicenter study: control group (ie, traditional learning) and experimental group (ie, Ecofisio mobile app). Participants? theoretical knowledge was assessed using a multiple-choice questionnaire (MCQ); students were also assessed by means of the Objective Structured Clinical Examination (OSCE). Moreover, a satisfaction survey was completed by the students. Results: The statistical analyses revealed that Ecofisio was effective in most of the processes evaluated when compared with the traditional learning method: all OSCE stations, P<.001; MCQ, 43 versus 15 students passed in the Ecofisio and control groups, respectively, P<.001. Moreover, the results revealed that the students found the app to be attractive and useful. Conclusions: The Ecofisio mobile app may be an effective way for physiotherapy students to obtain adequate professional competencies regarding evaluation and diagnosis of sports pathologies. Trial Registration: ClinicalTrials.gov NCT04138511; https://clinicaltrials.gov/ct2/show/NCT04138511 UR - https://www.jmir.org/2020/3/e16258 UR - http://dx.doi.org/10.2196/16258 UR - http://www.ncbi.nlm.nih.gov/pubmed/32154784 ID - info:doi/10.2196/16258 ER - TY - JOUR AU - Loda, Teresa AU - Erschens, Rebecca AU - Junne, Florian AU - Stengel, Andreas AU - Zipfel, Stephan AU - Herrmann-Werner, Anne PY - 2020/3/2 TI - Undergraduate Medical Students? Search for Health Information Online: Explanatory Cross-Sectional Study JO - JMIR Med Inform SP - e16279 VL - 8 IS - 3 KW - digital health literacy KW - medical education KW - evidence-based online information KW - digital native KW - trustworthy webpages N2 - Background: Previous research shows that being a ?digital native? or growing up in a digital environment does not necessarily lead to increased digital competencies, such as digital health literacy or evaluation of webpage quality. Objective: This study showed how medical students searched for health information online, specifically the recommended testing for histamine intolerance, by comparing the use of various search engines (Google, Medisuch, and a website of the student?s choice) to find out more about search strategies in future health professionals. As Medisuch presents a qualitatively better search engine, we assumed that medical students using this search engine might find valid information faster on more reliable webpages, and might recommend the correct diagnostic steps for histamine intolerance to their patients more often than students using a generic search engine like Google. Methods: Medical students in their third year of study were asked to find the relevant diagnostic steps of histamine intolerance online. They were randomly assigned to use one search engine: Google, their personal choice, or Medisuch. Their process of seeking information online was video recorded. Results: In total, 140 medical students participated in this study. The total number of webpages found did not differ among the groups (P=.52). Students using Medisuch (P=.02) correctly identified the elimination diet as a relevant diagnostic step more frequently. The provocation test was reported by almost half of the students independent of the search engine used. In general, medical students commonly identified trustworthy webpages in all three groups (Google: 36/44, 82%; free choice: 31/36; 86%; and Medisuch: 35/45, 78%). Conclusions: The results indicate that medical students were able to find trustworthy health-related information online independent of the search engine used. Medical students that are digital natives seem to have proper internet skills and a knowledge of how to use them. They entered specific medical terms (evidence-based diagnostic steps) or names of reliable webpages (DocCheck) in the search engines to gain correct information. However, it remains to be seen if this behavior can be called true ?digital literacy?. UR - https://medinform.jmir.org/2020/3/e16279 UR - http://dx.doi.org/10.2196/16279 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130146 ID - info:doi/10.2196/16279 ER - TY - JOUR AU - Al-Jaberi, Abdulwahid Musheer AU - Juni, Hanafiah Muhamad AU - Kadir Shahar, Hayati AU - Ismail, Fadhilah Siti Irma AU - Saeed, Abdu Murad AU - Ying, Poh Lim PY - 2020/2/27 TI - Effectiveness of an Educational Intervention in Reducing New International Postgraduates? Acculturative Stress in Malaysian Public Universities: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e12950 VL - 9 IS - 2 KW - acculturative stress KW - acculturation KW - international students KW - adjustment KW - protocol KW - cluster KW - randomized controlled trial N2 - Background: Universities around the world, including Malaysia, have attracted many international students from different countries. Research has reported that acculturative stress resulting from international students? attempts to adjust to the cultures of host countries is one of the most challenging issues that affects their lives in general and academic lives in particular. Objective: This study aims to examine the effectiveness of an educational intervention on acculturative stress among new postgraduate international students joining Malaysian public universities. Methods: A cluster randomized controlled trial design with Malaysian public universities as the unit of randomization will be used in this study. Public universities will be randomized in a 1:1 ratio to be either in the intervention (educational program) or control group (waiting list). Participants in the intervention group will receive 7 sessions in 9 hours delivered by an expert in psychology and the researcher. The control group will receive the intervention once the 3-month follow-up evaluation is completed. Results: The data will be analyzed using the generalized estimation equation with a confidence interval value of 95%; significant differences between and within groups are determined as P<.05. The results of the study underlie the effectiveness of educational program in decreasing acculturative stress of new international students and enabling them to cope with a new environment. The results of this study will contribute to previous knowledge of acculturative stress, acculturation, and adjustment of international students. Furthermore, such results are expected to play a role in raising university policy makers? awareness of their postgraduate international students? acculturative stress issues and how they can help them avoid such stress and perform well in their academic life. Conclusions: We expect that the intervention group will score significantly lower than the wait-list group on the immediate and 3-month postintervention evaluation of acculturative stress and achieve a higher level of adjustment. Results will have implications for international students, policy makers at universities, the Malaysian Ministry of Higher Education, and future research. Trial Registration: Clinical Trials Registry India CTRI/2018/01/011223; http://ctri.nic.in/Clinicaltrials/showallp.php?mid1= 21978&EncHid=&userName=Muhamad%20Hanafiah%20Juni International Registered Report Identifier (IRRID): PRR1-10.2196/12950 UR - http://www.researchprotocols.org/2020/2/e12950/ UR - http://dx.doi.org/10.2196/12950 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130180 ID - info:doi/10.2196/12950 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 - Guetterman, C. Timothy AU - Sakakibara, Rae AU - Baireddy, Srikar AU - Kron, W. Frederick AU - Scerbo, W. Mark AU - Cleary, F. James AU - Fetters, D. Michael PY - 2019/11/27 TI - Medical Students? Experiences and Outcomes Using a Virtual Human Simulation to Improve Communication Skills: Mixed Methods Study JO - J Med Internet Res SP - e15459 VL - 21 IS - 11 KW - cancer KW - virtual reality KW - health communication KW - interprofessional relations KW - informatics KW - nonverbal communication KW - computer simulation KW - physician-nurse relations KW - empathy N2 - Background: Attending to the wide range of communication behaviors that convey empathy is an important but often underemphasized concept to reduce errors in care, improve patient satisfaction, and improve cancer patient outcomes. A virtual human (VH)?based simulation, MPathic-VR, was developed to train health care providers in empathic communication with patients and in interprofessional settings and evaluated through a randomized controlled trial. Objective: This mixed methods study aimed to investigate the differential effects of a VH-based simulation developed to train health care providers in empathic patient-provider and interprofessional communication. Methods: We employed a mixed methods intervention design, involving a comparison of 2 quantitative measures?MPathic-VR?calculated scores and the objective structured clinical exam (OSCE) scores?with qualitative reflections by medical students about their experiences. This paper is a secondary, focused analysis of intervention arm data from the larger trial. Students at 3 medical schools in the United States (n=206) received simulation to improve empathic communication skills. We conducted analysis of variance, thematic text analysis, and merging mixed methods analysis. Results: OSCE scores were significantly improved for learners in the intervention group (mean 0.806, SD 0.201) compared with the control group (mean 0.752, SD 0.198; F1,414=6.09; P=.01). Qualitative analysis revealed 3 major positive themes for the MPathic-VR group learners: gaining useful communication skills, learning awareness of nonverbal skills in addition to verbal skills, and feeling motivated to learn more about communication. Finally, the results of the mixed methods analysis indicated that most of the variation between high, middle, and lower performers was noted about nonverbal behaviors. Medium and high OSCE scorers most often commented on the importance of nonverbal communication. Themes of motivation to learn about communication were only present in middle and high scorers. Conclusions: VHs are a promising strategy for improving empathic communication in health care. Higher performers seemed most engaged to learn, particularly nonverbal skills. UR - http://www.jmir.org/2019/11/e15459/ UR - http://dx.doi.org/10.2196/15459 UR - http://www.ncbi.nlm.nih.gov/pubmed/31774400 ID - info:doi/10.2196/15459 ER - TY - JOUR AU - Alyami, Hussain AU - Alawami, Mohammed AU - Lyndon, Mataroria AU - Alyami, Mohsen AU - Coomarasamy, Christin AU - Henning, Marcus AU - Hill, Andrew AU - Sundram, Frederick PY - 2019/9/26 TI - Impact of Using a 3D Visual Metaphor Serious Game to Teach History-Taking Content to Medical Students: Longitudinal Mixed Methods Pilot Study JO - JMIR Serious Games SP - e13748 VL - 7 IS - 3 KW - video games KW - instructional technology KW - memory KW - retention KW - metaphor KW - learning KW - clinical competence N2 - Background: History taking is a key component of clinical practice; however, this skill is often poorly performed by students and doctors. Objective: The study aimed to determine whether Metaphoria, a 3D serious game (SG), is superior to another electronic medium (PDF text file) in learning the history-taking content of a single organ system (cardiac). Methods: In 2015, a longitudinal mixed methods (quantitative and qualitative) pilot study was conducted over multiple sampling time points (10 weeks) on a group of undergraduate medical students at The University of Auckland Medical School, New Zealand. Assessors involved in the study were blinded to group allocation. From an initial sample of 83, a total of 46 medical students were recruited. Participants were assigned to either a PDF group (n=19) or a game group (n=27). In total, 1 participant left the PDF group after allocation was revealed and was excluded. A total of 24 students in the game group and 14 students in the PDF group completed follow-up 7 weeks later.Using an iterative design process for over a year, with input from a variety of clinical disciplines, a cardiac history-taking game and PDF file were designed and informed by Cognitive Load Theory. Each group completed its intervention in 40 min. A total of 3 levels of Kirkpatrick training evaluation model were examined using validated questionnaires: affective (perception and satisfaction), cognitive (knowledge gains and cognitive load), and behavioral attitudes (Objective Structured Clinical Exam) as well as qualitative assessment. A priori hypotheses were formulated before data collection. Results: Compared with baseline, both groups showed significant improvement in knowledge and self-efficacy longitudinally (P<.001). Apart from the game group having a statistically significant difference in terms of satisfaction (P<.001), there were no significant differences between groups in knowledge gain, self-efficacy, cognitive load, ease of use, acceptability, or objective structured clinical examination scores. However, qualitative findings indicated that the game was more engaging and enjoyable, and it served as a visual aid compared with the PDF file. Conclusions: Students favored learning through utilization of an SG with regard to cardiac history taking. This may be relevant to other areas of medicine, and this highlights the importance of innovative methods of teaching the next generation of medical students. UR - https://games.jmir.org/2019/3/e13748 UR - http://dx.doi.org/10.2196/13748 UR - http://www.ncbi.nlm.nih.gov/pubmed/31573895 ID - info:doi/10.2196/13748 ER - TY - JOUR AU - Nilsson, Mikael AU - Fors, Uno AU - Östergren, Jan AU - Bolinder, Gunilla AU - Edelbring, Samuel PY - 2019/07/11 TI - Why Medical Students Choose to Use or Not to Use a Web-Based Electrocardiogram Learning Resource: Mixed Methods Study JO - JMIR Med Educ SP - e12791 VL - 5 IS - 2 KW - learning KW - medical KW - teaching KW - electrocardiogram N2 - Background: Electrocardiogram (ECG) interpretation is a core competence and can make a significant difference to patient outcomes. However, ECG interpretation is a complex skill to learn, and research has showed that students often lack enough competence. Web-based learning has been shown to be effective. However, little is known regarding why and how students use Web-based learning when offered in a blended learning situation. Objective: The aim of this paper was to study students? use of Web-based ECG learning resources which has not previously been studied in relation to study strategies. Methods: A qualitative explanatory design using mixed methods was adopted to explore how medical students reason around their choice to use or not to use a Web-based ECG learning resource. Overall, 15 of 33 undergraduate medical students attending a course in clinical medicine were interviewed. Data on usage of the resource were obtained via the learning management system for all students. At the final examination, all the students answered a questionnaire on study strategies and questions about internet access and estimated their own skills in ECG interpretation. Furthermore, study strategies and use patterns were correlated with results from an ECG Objective Structured Clinical Examination (OSCE) and a written course examination. Results: In total, 2 themes were central in the students? reasoning about usage of Web-based ECG: assessment of learning needs and planning according to learning goals. Reasons for using the Web resource were to train in skills, regarding it as a valuable complement to books and lectures. The main reasons for not using the resource were believing they already had good enough skills and a lack of awareness of its availability. Usage data showed that 21 students (63%) used the Web resource. Of these, 11 were minimal users and 10 were major users based on usage activity. Large variations were found in the time spent in different functional parts of the resource. No differences were found between users and nonusers regarding the OSCE score, final examination score, self-estimate of knowledge, or favoring self-regulated learning. Conclusions: To use or not to use a Web-based ECG learning resource is largely based on self-regulated learning aspects. Decisions to use such a resource are based on multifactorial aspects such as experiences during clinical rotations, former study experiences, and perceived learning needs. The students? own judgment of whether there was a need for a Web-based resource to achieve the learning goals and to pass the examination was crucial for their decisions to use it or not. An increased understanding of students? regulation of learning and awareness of variations in their ECG learning needs can contribute to the improvement of course design for blended learning of ECG contexts for medical students. UR - https://mededu.jmir.org/2019/2/e12791/ UR - http://dx.doi.org/10.2196/12791 UR - http://www.ncbi.nlm.nih.gov/pubmed/31298220 ID - info:doi/10.2196/12791 ER - TY - JOUR AU - Kononowicz, A. Andrzej AU - Woodham, A. Luke AU - Edelbring, Samuel AU - Stathakarou, Natalia AU - Davies, David AU - Saxena, Nakul AU - Tudor Car, Lorainne AU - Carlstedt-Duke, Jan AU - Car, Josip AU - Zary, Nabil PY - 2019/07/02 TI - Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration JO - J Med Internet Res SP - e14676 VL - 21 IS - 7 KW - computer simulation KW - professional education KW - computer-assisted instruction KW - systematic review KW - meta-analysis N2 - Background: Virtual patients are interactive digital simulations of clinical scenarios for the purpose of health professions education. There is no current collated evidence on the effectiveness of this form of education. Objective: The goal of this study was to evaluate the effectiveness of virtual patients compared with traditional education, blended with traditional education, compared with other types of digital education, and design variants of virtual patients in health professions education. The outcomes of interest were knowledge, skills, attitudes, and satisfaction. Methods: We performed a systematic review on the effectiveness of virtual patient simulations in pre- and postregistration health professions education following Cochrane methodology. We searched 7 databases from the year 1990 up to September 2018. No language restrictions were applied. We included randomized controlled trials and cluster randomized trials. We independently selected studies, extracted data, and assessed risk of bias and then compared the information in pairs. We contacted study authors for additional information if necessary. All pooled analyses were based on random-effects models. Results: A total of 51 trials involving 4696 participants met our inclusion criteria. Furthermore, 25 studies compared virtual patients with traditional education, 11 studies investigated virtual patients as blended learning, 5 studies compared virtual patients with different forms of digital education, and 10 studies compared different design variants. The pooled analysis of studies comparing the effect of virtual patients to traditional education showed similar results for knowledge (standardized mean difference [SMD]=0.11, 95% CI ?0.17 to 0.39, I2=74%, n=927) and favored virtual patients for skills (SMD=0.90, 95% CI 0.49 to 1.32, I2=88%, n=897). Studies measuring attitudes and satisfaction predominantly used surveys with item-by-item comparison. Trials comparing virtual patients with different forms of digital education and design variants were not numerous enough to give clear recommendations. Several methodological limitations in the included studies and heterogeneity contributed to a generally low quality of evidence. Conclusions: Low to modest and mixed evidence suggests that when compared with traditional education, virtual patients can more effectively improve skills, and at least as effectively improve knowledge. The skills that improved were clinical reasoning, procedural skills, and a mix of procedural and team skills. We found evidence of effectiveness in both high-income and low- and middle-income countries, demonstrating the global applicability of virtual patients. Further research should explore the utility of different design variants of virtual patients. UR - https://www.jmir.org/2019/7/e14676/ UR - http://dx.doi.org/10.2196/14676 UR - http://www.ncbi.nlm.nih.gov/pubmed/31267981 ID - info:doi/10.2196/14676 ER - TY - JOUR AU - Van den Eynde, Jef AU - Crauwels, Alexander AU - Demaerel, Georg Philip AU - Van Eycken, Lisa AU - Bullens, Dominique AU - Schrijvers, Rik AU - Toelen, Jaan PY - 2019/05/28 TI - YouTube Videos as a Source of Information About Immunology for Medical Students: Cross-Sectional Study JO - JMIR Med Educ SP - e12605 VL - 5 IS - 1 KW - antigen presentation KW - education KW - immunoglobulins KW - immunology KW - learning KW - students N2 - Background: The use of the internet as a source of information has grown exponentially in the last decade. YouTube is currently the second most visited website and a major Web-based educational resource for medical students. Objective: The aim of this study was to evaluate the quality, accuracy, and attractiveness of the information acquired from YouTube videos about 2 central concepts in immunology. Methods: YouTube videos posted before August 27, 2018 were searched using selected keywords related to either antigen presentation or immunoglobulin gene rearrangement. Video characteristics were recorded, and the Video Power Index (VPI) was calculated. Videos were assessed using 5 validated scoring systems: understandability and attractiveness, reliability, content and comprehensiveness, global quality score (GQS), and a subjective score. Videos were categorized by educational usefulness and by source. Results: A total of 82 videos about antigen presentation and 70 about immunoglobulin gene rearrangement were analyzed. Videos had a mean understandability and attractiveness score of 6.57/8 and 5.84/8, content and comprehensiveness score of 9.84/20 and 5.84/20, reliability score of 1.65/4 and 1.53/4, GQS of 3.38/5 and 2.76/5, and subjective score of 2.00/3 and 2.00/3, respectively. The organized channels group tended to have the highest VPI and GQS. Conclusions: YouTube can provide medical students with some useful information about immunology, although content wise it cannot substitute textbooks and academic courses. Students and teachers should be aware of the educational quality of available videos if they intend to use them in the context of blended learning. UR - http://mededu.jmir.org/2019/1/e12605/ UR - http://dx.doi.org/10.2196/12605 UR - http://www.ncbi.nlm.nih.gov/pubmed/31140440 ID - info:doi/10.2196/12605 ER - TY - JOUR AU - Peters, Sanne AU - Clarebout, Geraldine AU - Aertgeerts, Bert AU - Leppink, Jimmie AU - Roex, Ann PY - 2019/04/12 TI - Supporting Students With Electronic Health Record?Embedded Learning Aids: A Mixed-Methods Study JO - JMIR Med Educ SP - e11351 VL - 5 IS - 1 KW - integrated learning KW - transfer of learning KW - electronic health record KW - electronic performance support system KW - learning aids KW - workplace learning N2 - Background: Students often perceive workplace-based learning as disconnected from what they learn in medical school. Interventions that deal with this issue regularly involve feedback and/or learning aids. Feedback has frequently been encouraged in previous research, whereas the use of aids is less understood. Objective: This study aims to investigate the added value of learning aids in making the connection and enhancing the transfer of learning between medical school and workplace-based learning. Methods: First-year students in postgraduate general practice training participated in a mixed-methods study. Within a quasi-experimental design, two conditions were investigated: (1) students having access to electronic health record (EHR)?embedded learning aids and feedback and (2) students only receiving feedback. Semistructured interviews were conducted and analyzed according to the thematic analysis approach. Results: Forty-four students participated in this study. No significant difference was found between the two conditions (t42=?0.511, P=.61, 95% CI ?4.86 to 2.90). Nevertheless, students used the aids frequently and found them useful. Given that the aids were familiar to students and contained practice-based instructions in an easily accessible format, they were perceived as feasible to use during workplace-based learning. They also appeared to stimulate transfer of learning, self-confidence, reflection, and interaction between student and supervisor. Conclusions: Access to EHR-embedded learning aids offers additional support during, but also before and after, patient encounters. The aids can be easily implemented into workplace-based learning. UR - http://mededu.jmir.org/2019/1/e11351/ UR - http://dx.doi.org/10.2196/11351 UR - http://www.ncbi.nlm.nih.gov/pubmed/30977741 ID - info:doi/10.2196/11351 ER - TY - JOUR AU - Park, Lily AU - Price-Williams, Steven AU - Jalali, Alireza AU - Pirzada, Kashif PY - 2019/04/09 TI - Increasing Access to Medical Training With Three-Dimensional Printing: Creation of an Endotracheal Intubation Model JO - JMIR Med Educ SP - e12626 VL - 5 IS - 1 KW - medical education KW - printing, three-dimensional N2 - Background: Endotracheal intubation (ETI) is a crucial life-saving procedure, where more than 2 failed attempts can lead to further complications or even death. Like all technical skills, ETI requires sufficient practice to perform adequately. Currently, the models used to practice ETI are expensive and, therefore, difficult to access, particularly in the developing world and in settings that lack a dedicated simulation center. Objective: This study aimed to improve access to ETI training by creating a comparable yet cost-effective simulation model producible by 3-dimensional (3D) printers. Methods: Open-source mesh files of relevant anatomy from BodyParts3D were modified through the 3D modeling programs Meshlab (ISTI-CNR) and Blender (Blender Foundation). Several prototypes with varying filaments were tried to optimize the ETI simulation. Results: We have created the novel 3D-printed pediatric ETI model for learners at all levels to practice this airway management skill at negligible costs compared with current simulation models. It is an open-source design available for all medical trainees. Conclusions: Revolutions in cost and ease of use have allowed home and even desktop 3D printers to become widespread. Therefore, open-source access to the ETI model will improve accessibility to medical training in the hopes of optimizing patient care. UR - http://mededu.jmir.org/2019/1/e12626/ UR - http://dx.doi.org/10.2196/12626 UR - http://www.ncbi.nlm.nih.gov/pubmed/30964444 ID - info:doi/10.2196/12626 ER - TY - JOUR AU - Klincova, Martina AU - Harazim, Hana AU - Schwarz, Daniel AU - Kosinova, Martina AU - Smekalova, Olga AU - Stourac, Petr PY - 2019/04/09 TI - What Can Be Achieved With Motivation-Based Teaching of Medical Students? A Monocentric Retrospective Audit of Retention Among Highly Motivated Graduates Who Underwent the Learning-by-Doing Concept in Anesthesiology and Intensive Care Medicine JO - JMIR Serious Games SP - e10155 VL - 7 IS - 2 KW - problem-based learning KW - virtual patients KW - anesthesiology KW - intensive care KW - specialization N2 - Background: Medical education, in general, is undergoing a significant shift from traditional methods. It becomes very difficult to discover effective teaching methods within the limited possibilities in patient hands-on education, especially as seen in anesthesiology and intensive care medicine (AIM) teaching. Motivation-based teaching is very popular in all other aspects of education, but it has received scant attention in medical education literature, even though it can make a real difference for both students and physicians. Objective: The primary aim of this retrospective audit was to find out if proper motivation-based teaching of students via the development of AKUTNE.CZ?s serious games can help retain graduates of the Faculty of Medicine of Masaryk University (FMMU) for the AIM specialty. Methods: Motivation-based teaching and the learning-by-doing concept were applied to a subject called Individual Project. Our topic, The Development of the Multimedia Educational Portal, AKUTNE.CZ, has been offered since 2010. The objective has been the development of supportive material in the form of interactive algorithms, serious games, and virtual patients for problem-based learning or team-based learning lectures aimed at acute medicine. We performed a retrospective questionnaire evaluation of all participants from the 2010-2017 period, focusing on their choice of medical specialty in 2017. The data were reported descriptively. Results: We evaluated 142 students who passed Individual Project with topic The Development of the Multimedia Educational Portal, AKUTNE.CZ during 2010 to 2017. In this period, they developed up to 77 electronic serious games in the form of interactive multimedia algorithms. Out of 139 students in general medicine, 108 students (77.7%) had already graduated and 37 graduates (34.3%) worked in the AIM specialty. Furthermore, 57 graduates (52.8%) chose the same specialty after graduation, matching the topic of their algorithm, and 37 (65%) of these graduates decided to pursue AIM. Conclusions: Motivation-based teaching and the concept of learning-by-doing by the algorithm/serious game development led to the significant retention of FMMU graduates in the AIM specialty. This concept could be considered successful, and as the concept itself can also be well integrated into the teaching of other medical specialties, the potential of motivation-based teaching should be used more broadly within medical education. UR - http://games.jmir.org/2019/2/e10155/ UR - http://dx.doi.org/10.2196/10155 UR - http://www.ncbi.nlm.nih.gov/pubmed/30964443 ID - info:doi/10.2196/10155 ER - TY - JOUR AU - Buijs-Spanjers, R. Kiki AU - Hegge, HM Harianne AU - Jansen, J. Carolien AU - Hoogendoorn, Evert AU - de Rooij, E. Sophia PY - 2018/10/26 TI - A Web-Based Serious Game on Delirium as an Educational Intervention for Medical Students: Randomized Controlled Trial JO - JMIR Serious Games SP - e17 VL - 6 IS - 4 KW - delirium KW - education KW - medical students KW - serious game N2 - Background: Adequate delirium recognition and management are important to reduce the incidence and severity of delirium. To improve delirium recognition and management, training of medical staff and students is needed. Objective: In this study, we aimed to gain insight into whether the serious game, Delirium Experience, is suited as an educational intervention. Methods: We conducted a three-arm randomized controlled trial. We enrolled 156 students in the third year of their Bachelor of Medical Sciences degree at the University Medical Centre Groningen. The Game group of this study played Delirium Experience. The Control D group watched a video with explanations on delirium and a patient?s experience of delirious episodes. The Control A group watched a video on healthy aging. To investigate students? skills, we used a video of a delirious patient for which students had to give care recommendations and complete the Delirium Observations Screening Scale and Delirium Rating Scale R-98. Furthermore, students completed the Delirium Attitude Scale, the Learning Motivation and Engagement Questionnaire, and self-reported knowledge on delirium. Results: In total, 156 students participated in this study (Game group, n=51; Control D group, n=51; Control A group, n=55). The Game group scored higher with a median (interquartile range) of 6 (4-8) for given recommendations and learning motivation and engagement compared with the Control D (1, 1-4) and A (0, 0-3) groups (P<.001). Furthermore, the Game group scored higher (7, 6-8) on self-reported knowledge compared with the Control A group (6, 5-6; P<.001). We did not find differences between the groups regarding delirium screening (P=.07) and rating (P=.45) skills or attitude toward delirious patients (P=.55). Conclusions: The serious game, Delirium Experience, is suitable as an educational intervention to teach delirium care to medical students and has added value in addition to a lecture. UR - http://games.jmir.org/2018/4/e17/ UR - http://dx.doi.org/10.2196/games.9886 UR - http://www.ncbi.nlm.nih.gov/pubmed/30368436 ID - info:doi/10.2196/games.9886 ER - TY - JOUR AU - Sheng, Y. Alexander AU - Chu, Andrew AU - Biancarelli, Dea AU - Drainoni, Mari-Lynn AU - Sullivan, Ryan AU - Schneider, I. Jeffrey PY - 2018/10/17 TI - A Novel Web-Based Experiential Learning Platform for Medical Students (Learning Moment): Qualitative Study JO - JMIR Med Educ SP - e10657 VL - 4 IS - 2 KW - experiential learning KW - reflection KW - shared learning N2 - Background: Experiential learning plays a critical role in learner development. Kolb?s 4-part experiential learning model consists of concrete experience, reflective observation, abstract conceptualization, and active experimentation in a recurring cycle. Most clinical environments provide opportunities for experiences and active experimentation but rarely offer structured means for reflection and abstract conceptualization that are crucial for learners to learn through experience. We created Learning Moment, a novel Web-based educational tool that integrates principles of asynchronous learning and learning portfolios to fulfill the reflection and abstract conceptualization aspects of Kolb?s learning cycle in the modern clinical learning environment. Medical students log concise clinical ?pearls? in the form of ?learning moments? for reflection, review, and sharing with peers in a community of practice. Objective: We sought to evaluate learners? experiences with Learning Moment via a qualitative study. Methods: We employed purposive sampling to recruit medical students who used Learning Moment during their rotation. We conducted 13 semistructured interviews (10 individual interviews and one 3-person group interview) between January and March 2017 using an ethnographic approach and utilized a general inductive method to analyze and code for potential themes. Results: A total of 13 students (five in their third year of medical school and eight in their fourth year) voluntarily participated in our qualitative interviews. Five of the 13 (38%) students intended to pursue emergency medicine as their chosen field of specialty. The median number of ?learning moments? logged by these students is 6. From our analysis, three key themes emerged relating to the perceived impact of Learning Moment on student learning: (1) logging ?learning moments? enhanced memorization, (2) improved learning through reflection, and (3) sharing of knowledge and experiences in a community of practice. Conclusions: Learning Moment was successfully implemented into the educational infrastructure in our department. Students identified three mechanisms by which the application optimizes experiential learning, including enabling the logging of ?learning moments? to promote memorization, encouraging reflection to facilitate learning, and fostering the sharing of knowledge and experiences within a community of practice. The Learning Moment concept is potentially scalable to other departments, disciplines, and institutions as we seek to optimize experiential learning ecosystems for all trainees. UR - http://mededu.jmir.org/2018/2/e10657/ UR - http://dx.doi.org/10.2196/10657 UR - http://www.ncbi.nlm.nih.gov/pubmed/30333094 ID - info:doi/10.2196/10657 ER - TY - JOUR AU - Fischer, Quentin AU - Sbissa, Yannis AU - Nhan, Pascal AU - Adjedj, Julien AU - Picard, Fabien AU - Mignon, Alexandre AU - Varenne, Olivier PY - 2018/9/24 TI - Use of Simulator-Based Teaching to Improve Medical Students? Knowledge and Competencies: Randomized Controlled Trial JO - J Med Internet Res SP - e261 VL - 20 IS - 9 KW - education KW - coronary angiography KW - high fidelity simulation training N2 - Background: Simulator-based teaching for coronary angiography (CA) is an attractive educational tool for medical students to improve their knowledge and skills. Its pedagogical impact has not been fully evaluated yet. Objective: The aim of this study was to compare traditional face-to-face teaching with a simulator-based teaching for the acquisition of coronary anatomy knowledge and CAs interpretation. Methods: A total of 118 medical school students in their fourth to sixth year were prospectively randomized in 2 groups: (1) a control teaching group (n=59, CONT group) and (2) a simulator group (using the Mentice VIST-Lab CA simulator; n=59, SIM group). The CONT group received a PowerPoint-based course, whereas the SIM group received a simulator-based course including the same information. After the course, all students were evaluated by 40 multiple choice questions (maximum of 100 points), including questions on coronary anatomy (part 1), angiographic projections (part 2), and real CAs interpretation (part 3). Satisfaction of the students was also evaluated by a simple questionnaire. Results: Student characteristics were identical in both the groups: 62/118 (52.5%) were female and age was 22.6 (SD 1.4) years. Moreover, 35.6% (42/118) were in their fourth year, 35.6% (42/118) were in the fifth year, and 28.8% (34/118) in the sixth year. During the evaluation, SIM students had higher global scores compared with CONT students, irrespective of their year of medical school (59.5 [SD 10.8] points vs 43.7 [SD 11.3] points, P<.001). The same observations were noted for each part of the test (36.9 [SD 6.6] points vs 29.6 [SD 6.9] points, P<.001; 5.9 [SD 3.0] points vs 3.1 [SD 2.8] points, P<.001; and 16.8 [SD 6.9] points vs 10.9 [SD 6.5] points, P<.001; for parts 1, 2, and 3, respectively). Student satisfaction was higher in the SIM group compared with the CONT group (98% vs 75%, P<.001). Conclusions: This study suggests that simulator-based teaching could potentially improve students? knowledge of coronary anatomy, angiography projections, and interpretation of real clinical cases, suggesting better clinical skills. These results should encourage further evaluation of simulator-based teaching in other medical specialties and how they can translate into clinical practice. UR - http://www.jmir.org/2018/9/e261/ UR - http://dx.doi.org/10.2196/jmir.9634 UR - http://www.ncbi.nlm.nih.gov/pubmed/30249587 ID - info:doi/10.2196/jmir.9634 ER - TY - JOUR AU - Hartnup, Becky AU - Dong, Lin AU - Eisingerich, Benedikt Andreas PY - 2018/07/13 TI - How an Environment of Stress and Social Risk Shapes Student Engagement With Social Media as Potential Digital Learning Platforms: Qualitative Study JO - JMIR Med Educ SP - e10069 VL - 4 IS - 2 KW - social media KW - online learning KW - digital engagement KW - stress KW - social risk KW - digital platforms KW - education KW - university adjustment N2 - Background: Social media has been increasingly used as a learning tool in medical education. Specifically, when joining university, students often go through a phase of adjustment, and they need to cope with various challenges such as leaving their families and friends and trying to fit into a new environment. Research has shown that social media helps students to connect with old friends and to establish new relationships. However, managing friendships on social media might intertwine with the new learning environment that shapes students? online behaviors. Especially, when students perceive high levels of social risks when using social media, they may struggle to take advantage of the benefits that social media can provide for learning. Objective: This study aimed to develop a model that explores the drivers and inhibitors of student engagement with social media during their university adjustment phase. Methods: We used a qualitative method by interviewing 78 undergraduate students studying medical courses at UK research-focused universities. In addition, we interviewed 6 digital technology experts to provide additional insights into students? learning behaviors on social media. Results: Students? changing relationships and new academic environment in the university adjustment phase led to various factors that affected their social media engagement. The main drivers of social media engagement were maintaining existing relationships, building new relationships, and seeking academic support. Simultaneously, critical factors that inhibited the use of social media for learning emerged, namely, collapsed online identity, uncertain group norms, the desire to present an ideal self, and academic competition. These inhibitors led to student stress when managing their social media accounts, discouraged them from actively engaging on social media, and prevented the full exploitation of social media as an effective learning tool. Conclusions: This study identified important drivers and inhibitors for students to engage with social media platforms as learning tools. Although social media supported students to manage their relationships and support their learning, the interaction of critical factors, such as collapsed online identity, uncertain group norms, the desire to present an ideal self, and academic competition, caused psychological stress and impeded student engagement. Future research should explore how these inhibitors can be removed to reduce students? stress and to increase the use of social media for learning. More specifically, such insights will allow students to take full advantage of being connected, thus facilitating a richer learning experience during their university life. UR - http://mededu.jmir.org/2018/2/e10069/ UR - http://dx.doi.org/10.2196/10069 UR - http://www.ncbi.nlm.nih.gov/pubmed/30006324 ID - info:doi/10.2196/10069 ER - TY - JOUR AU - Pascoe, Michael AU - Monroe, Forrest AU - Macfarlane, Helen PY - 2018/06/14 TI - Taking Constructivism One Step Further: Post Hoc Analysis of a Student-Created Wiki JO - JMIR Med Educ SP - e16 VL - 4 IS - 1 KW - wiki KW - constructivist learning KW - medical education KW - analytics N2 - Background: Wiki platform use has potential to improve student learning by improving engagement with course material. A student-created wiki was established to serve as a repository of study tools for students in a medical school curriculum. There is a scarcity of information describing student-led creation of wikis in medical education. Objective: The aim is to characterize website traffic of a student-created wiki and evaluate student perceptions of usage via a short anonymous online survey. Methods: Website analytics were used to track visitation statistics to the wiki and a survey was distributed to assess ease of use, interest in contributing to the wiki, and suggestions for improvement. Results: Site traffic data indicated high usage, with a mean of 315 (SD 241) pageviews per day from July 2011 to March 2013 and 74,317 total user sessions. The mean session duration was 1.94 (SD 1.39) minutes. Comparing Fall 2011 to Fall 2012 sessions revealed a large increase in returning visitors (from 12,397 to 20,544, 65.7%) and sessions via mobile devices (831 to 1560, 87.7%). The survey received 164 responses; 88.0% (162/184) were aware of the wiki at the time of the survey. On average, respondents felt that the wiki was more useful in the preclinical years (mean 2.73, SD 1.25) than in the clinical years (mean 1.88, SD 1.12; P<.001). Perceived usefulness correlated with the percent of studying for which the respondent used electronic resources (Spearman ?=.414, P<.001). Conclusions: Overall, the wiki was a highly utilized, although informal, part of the curriculum with much room for improvement and future exploration. UR - http://mededu.jmir.org/2018/1/e16/ UR - http://dx.doi.org/10.2196/mededu.9197 UR - http://www.ncbi.nlm.nih.gov/pubmed/29903697 ID - info:doi/10.2196/mededu.9197 ER - TY - JOUR AU - Haubruck, Patrick AU - Nickel, Felix AU - Ober, Julian AU - Walker, Tilman AU - Bergdolt, Christian AU - Friedrich, Mirco AU - Müller-Stich, Peter Beat AU - Forchheim, Franziska AU - Fischer, Christian AU - Schmidmaier, Gerhard AU - Tanner, C. Michael PY - 2018/05/21 TI - Evaluation of App-Based Serious Gaming as a Training Method in Teaching Chest Tube Insertion to Medical Students: Randomized Controlled Trial JO - J Med Internet Res SP - e195 VL - 20 IS - 5 KW - games, experimental KW - education, professional KW - general surgery KW - emergency medicine KW - problem-based learning KW - chest tubes KW - simulation training KW - clinical competence N2 - Background: The insertion of a chest tube should be as quick and accurate as possible to maximize the benefit and minimize possible complications for the patient. Therefore, comprehensive training and assessment before an emergency situation are essential for proficiency in chest tube insertion. Serious games have become more prevalent in surgical training because they enable students to study and train a procedure independently, and errors made have no effect on patients. However, up-to-date evidence regarding the effect of serious games on performance in procedures in emergency medicine remains scarce. Objective: The aim of this study was to investigate the serious gaming approach in teaching medical students an emergency procedure (chest tube insertion) using the app Touch Surgery and a modified objective structural assessment of technical skills (OSATS). Methods: In a prospective, rater-blinded, randomized controlled trial, medical students were randomized into two groups: intervention group or control group. Touch Surgery has been established as an innovative and cost-free app for mobile devices. The fully automatic software enables users to train medical procedures and afterwards self-assess their training effort. The module chest tube insertion teaches each key step in the insertion of a chest tube and enables users the meticulous application of a chest tube. In contrast, the module ?Thoracocentesis? discusses a basic thoracocentesis. All students attended a lecture regarding chest tube insertion (regular curriculum) and afterwards received a Touch Surgery training lesson: intervention group used the module chest tube insertion and the control group used Thoracocentesis as control training. Participants? performance in chest tube insertion on a porcine model was rated on-site via blinded face-to-face rating and via video recordings using a modified OSATS tool. Afterwards, every participant received an individual questionnaire for self-evaluation. Here, trainees gave information about their individual training level, as well as previous experiences, gender, and hobbies. Primary end point was operative performance during chest tube insertion by direct observance. Results: A total of 183 students enrolled, 116 students participated (63.4%), and 21 were excluded because of previous experiences in chest tube insertion. Students were randomized to the intervention group (49/95, 52%) and control group (46/95, 48%). The intervention group performed significantly better than the control group (Intervention group: 38.0 [I50=7.0] points; control group: 30.5 [I50=8.0] points; P<.001). The intervention group showed significantly improved economy of time and motion (P=.004), needed significantly less help (P<.001), and was more confident in handling of instruments (P<.001) than the control group. Conclusions: The results from this study show that serious games are a valid and effective tool in education of operative performance in chest tube insertion. We believe that serious games should be implemented in the surgical curriculum, as well as residency programs, in addition to traditional learning methods. Trial Registration: German Clinical Trials Register (DRKS) DRKS00009994; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00009994 (Archived by Webcite at http://www.webcitation.org/6ytWF1CWg) UR - http://www.jmir.org/2018/5/e195/ UR - http://dx.doi.org/10.2196/jmir.9956 UR - http://www.ncbi.nlm.nih.gov/pubmed/29784634 ID - info:doi/10.2196/jmir.9956 ER - TY - JOUR AU - Alexander, George Andrew AU - Deas, Deborah AU - Lyons, Eric Paul PY - 2018/05/18 TI - An Internet-Based Radiology Course in Medical School: Comparison of Academic Performance of Students on Campus Versus Those With Absenteeism Due to Residency Interviews JO - JMIR Med Educ SP - e14 VL - 4 IS - 1 KW - radiology clerkship KW - online education KW - imaging KW - radiology rotation KW - Web-based education N2 - Background: Imaging and its optimal use are imperative to the practice of medicine, yet many students don?t receive a formal education in radiology. Concurrently, students look for ways to take time away from medical school for residency interviewing. Web-based instruction provides an opportunity to combine these imperatives using online modalities. Objective: A largely Web-based course in radiology during the 4th year of medical school was evaluated both for its acceptance to students who needed to be away from campus for interviews, and its effectiveness on a nationally administered standardized test. Methods: All students were placed into a structured program utilizing online videos, online modules, online textbook assignments, and live interactive online lectures. Over half of the course could be completed away from campus. The Alliance of Medical Student Educators in Radiology test exam bank was used as a final exam to evaluate medical knowledge. Results: Positive student feedback included the freedom to travel for interviews, hands-on ultrasound training, interactive teaching sessions, and quality Web-based learning modules. Negative feedback included taking quizzes in-person, a perceived outdated online textbook, and physically shadowing hospital technicians. Most students elected to take the course during the interview months of October through January. The Alliance of Medical Student Educators in Radiology final exam results (70.5%) were not significantly different than the national cohort (70%) who took the course in-person. Test scores from students taking the course during interview travel months were not significantly different from students who took the course before (P=.30) or after (P=.34) the interview season. Conclusions: Students desire to learn radiology and often choose to do so when they need to be away from campus during the fall of their 4th year of study to accomplish their residency interviews. Web-based education in radiology allows students? interview traveling and radiology course objectives to be successfully met without adversely affecting the outcomes on a nationally normed examination in radiology. A curriculum that includes online content and live Web-based teleconference access to faculty can accomplish both imperatives. UR - http://mededu.jmir.org/2018/1/e14/ UR - http://dx.doi.org/10.2196/mededu.8747 UR - http://www.ncbi.nlm.nih.gov/pubmed/29776902 ID - info:doi/10.2196/mededu.8747 ER - TY - JOUR AU - Tang, Brandon AU - Coret, Alon AU - Qureshi, Aatif AU - Barron, Henry AU - Ayala, Patricia Ana AU - Law, Marcus PY - 2018/04/10 TI - Online Lectures in Undergraduate Medical Education: Scoping Review JO - JMIR Med Educ SP - e11 VL - 4 IS - 1 KW - online lectures KW - undergraduate medical education KW - multimedia design KW - assessment KW - scoping review KW - e-learning N2 - Background: The adoption of the flipped classroom in undergraduate medical education calls on students to learn from various self-paced tools?including online lectures?before attending in-class sessions. Hence, the design of online lectures merits special attention, given that applying multimedia design principles has been shown to enhance learning outcomes. Objective: The aim of this study was to understand how online lectures have been integrated into medical school curricula, and whether published literature employs well-accepted principles of multimedia design. Methods: This scoping review followed the methodology outlined by Arksey and O'Malley (2005). Databases, including MEDLINE, PsycINFO, Education Source, FRANCIS, ERIC, and ProQuest, were searched to find articles from 2006 to 2016 related to online lecture use in undergraduate medical education. Results: In total, 45 articles met our inclusion criteria. Online lectures were used in preclinical and clinical years, covering basic sciences, clinical medicine, and clinical skills. The use of multimedia design principles was seldom reported. Almost all studies described high student satisfaction and improvement on knowledge tests following online lecture use. Conclusions: Integration of online lectures into undergraduate medical education is well-received by students and appears to improve learning outcomes. Future studies should apply established multimedia design principles to the development of online lectures to maximize their educational potential. UR - http://mededu.jmir.org/2018/1/e11/ UR - http://dx.doi.org/10.2196/mededu.9091 UR - http://www.ncbi.nlm.nih.gov/pubmed/29636322 ID - info:doi/10.2196/mededu.9091 ER - TY - JOUR AU - Lee, Li-Ang AU - Wang, Shu-Ling AU - Chao, Yi-Ping AU - Tsai, Ming-Shao AU - Hsin, Li-Jen AU - Kang, Chung-Jan AU - Fu, Chia-Hsiang AU - Chao, Wei-Chieh AU - Huang, Chung-Guei AU - Li, Hsueh-Yu AU - Chuang, Cheng-Keng PY - 2018/03/08 TI - Mobile Technology in E-Learning for Undergraduate Medical Education on Emergent Otorhinolaryngology?Head and Neck Surgery Disorders: Pilot Randomized Controlled Trial JO - JMIR Med Educ SP - e8 VL - 4 IS - 1 KW - e-learning KW - gamification KW - mobile technology KW - randomized controlled trial KW - video lecture N2 - Background: The use of mobile technology in e-learning (M-TEL) can add new levels of experience and significantly increase the attractiveness of e-learning in medical education. Whether an innovative interactive e-learning multimedia (IM) module or a conventional PowerPoint show (PPS) module using M-TEL to teach emergent otorhinolaryngology?head and neck surgery (ORL-HNS) disorders is feasible and efficient in undergraduate medical students is unknown. Objective: The aim of this study was to compare the impact of a novel IM module with a conventional PPS module using M-TEL for emergent ORL-HNS disorders with regard to learning outcomes, satisfaction, and learning experience. Methods: This pilot study was conducted at an academic teaching hospital and included 24 undergraduate medical students who were novices in ORL-HNS. The cognitive style was determined using the Group Embedded Figures Test. The participants were randomly allocated (1:1) to one of the two groups matched by age, sex, and cognitive style: the IM group and the PPS group. During the 100-min learning period, the participants were unblinded to use the IM or PPS courseware on a 7-inch tablet. Pretests and posttests using multiple-choice questions to evaluate knowledge and multimedia situational tests to evaluate competence were administered. Participants evaluated their satisfaction and learning experience by the AttrakDiff2 questionnaire, and provided feedback about the modules. Results: Overall, the participants had significant gains in knowledge (median of percentage change 71, 95% CI 1-100, P<.001) and competence (median of percentage change 25, 95% CI 0-33, P=.007) after 100 min of learning. Although there was no significant difference in knowledge gain between the two groups (median of difference of percentage change 24, 95% CI ?75 to 36; P=.55), competence gain was significantly lower in the IM group compared with the PPS group (median of difference of percentage change ?41, 95% CI ?67 to ?20; P=.008). However, the IM group had significantly higher scores of satisfaction (difference 2, 95% CI 2-4; P=.01), pragmatic quality (difference 1.7, 95% CI 0.1-2.7; P=.03), and hedonic stimulation (difference 1.9, 95% CI 0.3-3.1; P=.01) compared with the PPS group. Qualitative feedback indicated that the various games in the IM module attracted the participants? attention but that the nonlinearly arranged materials affected their learning. Conclusions: Using M-TEL for undergraduate medical education on emergent ORL-HNS disorders, an IM module seems to be useful for gaining knowledge, but competency may need to occur elsewhere. While the small sample size reduces the statistical power of our results, its design seems to be appropriate to determine the effects of M-TEL using a larger group. Trial Registration: ClinicalTrials.gov NCT02971735; https://clinicaltrials.gov/ct2/show/NCT02971735 (Archived by WebCite at http://www.webcitation.org/6waoOpCEV) UR - http://mededu.jmir.org/2018/1/e8/ UR - http://dx.doi.org/10.2196/mededu.9237 UR - http://www.ncbi.nlm.nih.gov/pubmed/29519776 ID - info:doi/10.2196/mededu.9237 ER - TY - JOUR AU - Bergeron, David AU - Champagne, Jean-Nicolas AU - Qi, Wen AU - Dion, Maxime AU - Thériault, Julie AU - Renaud, Jean-Sébastien PY - 2018/02/22 TI - Impact of a Student-Driven, Virtual Patient Application on Objective Structured Clinical Examination Performance: Observational Study JO - J Med Internet Res SP - e60 VL - 20 IS - 2 KW - peer-assisted learning KW - virtual patient KW - medical education KW - undergraduate N2 - Background: Peer-assisted learning (PAL) refers to a learning activity whereby students of similar academic level teach and learn from one another. Groupe de perfectionnement des habiletés cliniques (Clinical Skills Improvement Group), a student organization at Université Laval, Canada, propelled PAL into the digital era by creating a collaborative virtual patient platform. Medical interviews can be completed in pairs (a student-patient and a student-doctor) through an interactive Web-based application, which generates a score (weighted for key questions) and automated feedback. Objectives: The aim of the study was to measure the pedagogical impact of the application on the score at medical interview stations at the summative preclerkship Objective Structured Clinical Examination (OSCE). Methods: We measured the use of the application (cases completed, mean score) in the 2 months preceding the OSCE. We also accessed the results of medical interview stations at the preclerkship summative OSCE. We analyzed whether using the application was associated with higher scores and/or better passing grades (?60%) at the OSCE. Finally, we produced an online form where students could comment on their appreciation of the application. Results: Of the 206 students completing the preclerkship summative OSCE, 170 (82.5%) were registered users on the application, completing a total of 3133 cases (18 by active user in average, 7 minutes by case in average). The appreciation questionnaire was answered online by 45 students who mentioned appreciating the intuitive, easy-to-use, and interactive design, the diversity of cases, and the automated feedback. Using the application was associated with reduced reported stress, improved scores (P=.04), and improved passing rates (P=.11) at the preclerkship summative OSCE. Conclusions: This study suggests that PAL can go far beyond small-group teaching, showing students? potential to create helpful pedagogical tools for their peers. UR - http://www.jmir.org/2018/2/e60/ UR - http://dx.doi.org/10.2196/jmir.7548 UR - http://www.ncbi.nlm.nih.gov/pubmed/29472175 ID - info:doi/10.2196/jmir.7548 ER - TY - JOUR AU - Lee, Li-Ang AU - Chao, Yi-Ping AU - Huang, Chung-Guei AU - Fang, Ji-Tseng AU - Wang, Shu-Ling AU - Chuang, Cheng-Keng AU - Kang, Chung-Jan AU - Hsin, Li-Jen AU - Lin, Wan-Ni AU - Fang, Tuan-Jen AU - Li, Hsueh-Yu PY - 2018/02/13 TI - Cognitive Style and Mobile E-Learning in Emergent Otorhinolaryngology-Head and Neck Surgery Disorders for Millennial Undergraduate Medical Students: Randomized Controlled Trial JO - J Med Internet Res SP - e56 VL - 20 IS - 2 KW - cognitive style KW - e-learning KW - mobile technology KW - randomized controlled trial N2 - Background: Electronic learning (e-learning) through mobile technology represents a novel way to teach emergent otorhinolaryngology-head and neck surgery (ORL-HNS) disorders to undergraduate medical students. Whether a cognitive style of education combined with learning modules can impact learning outcomes and satisfaction in millennial medical students is unknown. Objective: The aim of this study was to assess the impact of cognitive styles and learning modules using mobile e-learning on knowledge gain, competence gain, and satisfaction for emergent ORL-HNS disorders. Methods: This randomized controlled trial included 60 undergraduate medical students who were novices in ORL-HNS at an academic teaching hospital. The cognitive style of the participants was assessed using the group embedded figures test. The students were randomly assigned (1:1) to a novel interactive multimedia (IM) group and conventional Microsoft PowerPoint show (PPS) group matched by age, sex, and cognitive style. The content for the gamified IM module was derived from and corresponded to the textbook-based learning material of the PPS module (video lectures). The participants were unblinded and used fully automated courseware containing the IM or PPS module on a 7-inch tablet for 100 min. Knowledge and competence were assessed using multiple-choice questions and multimedia situation tests, respectively. Each participant also rated their global satisfaction. Results: All of the participants (median age 23 years, range 22-26 years; 36 males and 24 females) received the intended intervention after randomization. Overall, the participants had significant gains in knowledge (median 50%, interquartile range [IQR]=17%-80%, P<.001) and competence (median 13%, IQR=0%-33%, P=.006). There were no significant differences in knowledge gain (40%, IQR=13%-76% vs 60%, IQR=20%-100%, P=.42) and competence gain (0%, IQR= ?21% to 38% vs 25%, IQR=0%-33%, P=.16) between the IM and PPS groups. However, the IM group had a higher satisfaction score (8, IQR=6-9 vs 6, IQR=4-7, P=.01) compared with the PPS group. Using Friedman?s two-way nonparametric analysis of variance, cognitive styles (field-independent, field-intermediate, or field-dependent classification) and learning modules (IM or PPS) had significant effects on both knowledge gain (both adjusted P<.001) and satisfaction (both adjusted P<.001). Conclusions: Mobile e-learning is an effective modality to improve knowledge of emergent ORL-HNS in millennial undergraduate medical students. Our findings suggest the necessity of developing various modules for undergraduate medical students with different cognitive styles. Trial Registration: Clinicaltrials.gov NCT02971735; https://clinicaltrials.gov/ct2/show/NCT02971735 (Archived by WebCite at http://www.webcitation.org/6waoOpCEV) UR - http://www.jmir.org/2018/2/e56/ UR - http://dx.doi.org/10.2196/jmir.8987 UR - http://www.ncbi.nlm.nih.gov/pubmed/29439943 ID - info:doi/10.2196/jmir.8987 ER - TY - JOUR AU - Hege, Inga AU - Kononowicz, A. Andrzej AU - Adler, Martin PY - 2017/11/02 TI - A Clinical Reasoning Tool for Virtual Patients: Design-Based Research Study JO - JMIR Med Educ SP - e21 VL - 3 IS - 2 KW - learning KW - educational technology KW - computer-assisted instruction KW - clinical decision-making N2 - Background: Clinical reasoning is a fundamental process medical students have to learn during and after medical school. Virtual patients (VP) are a technology-enhanced learning method to teach clinical reasoning. However, VP systems do not exploit their full potential concerning the clinical reasoning process; for example, most systems focus on the outcome and less on the process of clinical reasoning. Objectives: Keeping our concept grounded in a former qualitative study, we aimed to design and implement a tool to enhance VPs with activities and feedback, which specifically foster the acquisition of clinical reasoning skills. Methods: We designed the tool by translating elements of a conceptual clinical reasoning learning framework into software requirements. The resulting clinical reasoning tool enables learners to build their patient?s illness script as a concept map when they are working on a VP scenario. The student?s map is compared with the experts? reasoning at each stage of the VP, which is technically enabled by using Medical Subject Headings, which is a comprehensive controlled vocabulary published by the US National Library of Medicine. The tool is implemented using Web technologies, has an open architecture that enables its integration into various systems through an open application program interface, and is available under a Massachusetts Institute of Technology license. Results: We conducted usability tests following a think-aloud protocol and a pilot field study with maps created by 64 medical students. The results show that learners interact with the tool but create less nodes and connections in the concept map than an expert. Further research and usability tests are required to analyze the reasons. Conclusions: The presented tool is a versatile, systematically developed software component that specifically supports the clinical reasoning skills acquisition. It can be plugged into VP systems or used as stand-alone software in other teaching scenarios. The modular design allows an extension with new feedback mechanisms and learning analytics algorithms. UR - http://mededu.jmir.org/2017/2/e21/ UR - http://dx.doi.org/10.2196/mededu.8100 UR - http://www.ncbi.nlm.nih.gov/pubmed/29097355 ID - info:doi/10.2196/mededu.8100 ER - TY - JOUR AU - Judd, Terry AU - Elliott, Kristine PY - 2017/10/02 TI - Selection and Use of Online Learning Resources by First-Year Medical Students: Cross-Sectional Study JO - JMIR Med Educ SP - e17 VL - 3 IS - 2 KW - information-seeking behaviors KW - educational technologies KW - e-learning KW - learning analytics N2 - Background: Medical students have access to a wide range of learning resources, many of which have been specifically developed for or identified and recommended to them by curriculum developers or teaching staff. There is an expectation that students will access and use these resources to support their self-directed learning. However, medical educators lack detailed and reliable data about which of these resources students use to support their learning and how this use relates to key learning events or activities. Objective: The purpose of this study was to comprehensively document first-year medical student selection and use of online learning resources to support their bioscience learning within a case-based curriculum and assess these data in relation to our expectations of student learning resource requirements and use. Methods: Study data were drawn from 2 sources: a survey of student learning resource selection and use (2013 cohort; n=326) and access logs from the medical school learning platform (2012 cohort; n=337). The paper-based survey, which was distributed to all first-year students, was designed to assess the frequency and types of online learning resources accessed by students and included items about their perceptions of the usefulness, quality, and reliability of various resource types and sources. Of 237 surveys returned, 118 complete responses were analyzed (36.2% response rate). Usage logs from the learning platform for an entire semester were processed to provide estimates of first-year student resource use on an individual and cohort-wide basis according to method of access, resource type, and learning event. Results: According to the survey data, students accessed learning resources via the learning platform several times per week on average, slightly more often than they did for resources from other online sources. Google and Wikipedia were the most frequently used nonuniversity sites, while scholarly information sites (eg, online journals and scholarly databases) were accessed relatively infrequently. Students were more likely to select learning resources based on the recommendation of peers than of teaching staff. The overwhelming majority of the approximately 70,000 resources accessed by students via the learning platform were lecture notes, with each accessed an average of 167 times. By comparison, recommended journal articles and (online) textbook chapters were accessed only 49 and 31 times, respectively. The number and type of learning resources accessed by students through the learning platform was highly variable, with a cluster analysis revealing that a quarter of students accessed very few resources in this way. Conclusions: Medical students have easy access to a wide range of quality learning resources, and while some make good use of the learning resources recommended to them, many ignore most and access the remaining ones infrequently. Learning analytics can provide useful measures of student resource access through university learning platforms but fails to account for resources accessed via external online sources or sharing of resources using social media. UR - http://mededu.jmir.org/2017/2/e17/ UR - http://dx.doi.org/10.2196/mededu.7382 UR - http://www.ncbi.nlm.nih.gov/pubmed/28970187 ID - info:doi/10.2196/mededu.7382 ER - TY - JOUR AU - Adjedj, Julien AU - Ducrocq, Gregory AU - Bouleti, Claire AU - Reinhart, Louise AU - Fabbro, Eleonora AU - Elbez, Yedid AU - Fischer, Quentin AU - Tesniere, Antoine AU - Feldman, Laurent AU - Varenne, Olivier PY - 2017/05/16 TI - Medical Student Evaluation With a Serious Game Compared to Multiple Choice Questions Assessment JO - JMIR Serious Games SP - e11 VL - 5 IS - 2 KW - serious game KW - multiple choice questions KW - medical student KW - student evaluation N2 - Background: The gold standard for evaluating medical students? knowledge is by multiple choice question (MCQs) tests: an objective and effective means of restituting book-based knowledge. However, concerns have been raised regarding their effectiveness to evaluate global medical skills. Furthermore, MCQs of unequal difficulty can generate frustration and may also lead to a sizable proportion of close results with low score variability. Serious games (SG) have recently been introduced to better evaluate students? medical skills. Objectives: The study aimed to compare MCQs with SG for medical student evaluation. Methods: We designed a cross-over randomized study including volunteer medical students from two medical schools in Paris (France) from January to September 2016. The students were randomized into two groups and evaluated either by the SG first and then the MCQs, or vice-versa, for a cardiology clinical case. The primary endpoint was score variability evaluated by variance comparison. Secondary endpoints were differences in and correlation between the MCQ and SG results, and student satisfaction. Results: A total of 68 medical students were included. The score variability was significantly higher in the SG group (?2 =265.4) than the MCQs group (?2=140.2; P=.009). The mean score was significantly lower for the SG than the MCQs at 66.1 (SD 16.3) and 75.7 (SD 11.8) points out of 100, respectively (P<.001). No correlation was found between the two test results (R2=0.04, P=.58). The self-reported satisfaction was significantly higher for SG (P<.001). Conclusions: Our study suggests that SGs are more effective in terms of score variability than MCQs. In addition, they are associated with a higher student satisfaction rate. SGs could represent a new evaluation modality for medical students. UR - http://games.jmir.org/2017/2/e11/ UR - http://dx.doi.org/10.2196/games.7033 UR - http://www.ncbi.nlm.nih.gov/pubmed/28512082 ID - info:doi/10.2196/games.7033 ER - TY - JOUR AU - Oliveira, Cristina Ana AU - Mattos, Sandra AU - Coimbra, Miguel PY - 2017/05/10 TI - Development and Assessment of an E-learning Course on Pediatric Cardiology Basics JO - JMIR Med Educ SP - e10 VL - 3 IS - 1 KW - distance learning KW - continuing medical education KW - pediatrics KW - cardiology KW - congenital heart defects N2 - Background: Early detection of congenital heart disease is a worldwide problem. This is more critical in developing countries, where shortage of professional specialists and structural health care problems are a constant. E-learning has the potential to improve capacity, by overcoming distance barriers and by its ability to adapt to the reduced time of health professionals. Objective: The study aimed to develop an e-learning pediatric cardiology basics course and evaluate its pedagogical impact and user satisfaction. Methods: The sample consisted of 62 health professionals, including doctors, nurses, and medical students, from 20 hospitals linked via a telemedicine network in Northeast Brazil. The course was developed using Moodle (Modular Object Oriented Dynamic Learning Environment; Moodle Pty Ltd, Perth, Australia) and contents adapted from a book on this topic. Pedagogical impact evaluation used a pre and posttest approach. User satisfaction was evaluated using Wang?s questionnaire. Results: Pedagogical impact results revealed differences in knowledge assessment before and after the course (Z=?4.788; P<.001). Questionnaire results indicated high satisfaction values (Mean=87%; SD=12%; minimum=67%; maximum=100%). Course adherence was high (79%); however, the withdrawal exhibited a value of 39%, with the highest rate in the early chapters. Knowledge gain revealed significant differences according to the profession (X22=8.6; P=.01) and specialty (X22=8.4; P=.04). Time dedication to the course was significantly different between specialties (X22=8.2; P=.04). Conclusions: The main contributions of this study are the creation of an asynchronous e-learning course on Moodle and the evaluation of its impact, confirming that e-learning is a viable tool to improve training in neonatal congenital heart diseases. UR - http://mededu.jmir.org/2017/1/e10/ UR - http://dx.doi.org/10.2196/mededu.5434 UR - http://www.ncbi.nlm.nih.gov/pubmed/28490416 ID - info:doi/10.2196/mededu.5434 ER - TY - JOUR AU - Katz, Aric AU - Tepper, Ronnie AU - Shtub, Avraham PY - 2017/04/21 TI - Simulation Training: Evaluating the Instructor?s Contribution to a Wizard of Oz Simulator in Obstetrics and Gynecology Ultrasound Training JO - JMIR Med Educ SP - e8 VL - 3 IS - 1 KW - distance learning KW - feedback KW - simulation training KW - evaluation research N2 - Background: Workplaces today demand graduates who are prepared with field-specific knowledge, advanced social skills, problem-solving skills, and integration capabilities. Meeting these goals with didactic learning (DL) is becoming increasingly difficult. Enhanced training methods that would better prepare tomorrow?s graduates must be more engaging and game-like, such as feedback based e-learning or simulation-based training, while saving time. Empirical evidence regarding the effectiveness of advanced learning methods is lacking. Objective quantitative research comparing advanced training methods with DL is sparse. Objectives: This quantitative study assessed the effectiveness of a computerized interactive simulator coupled with an instructor who monitored students? progress and provided Web-based immediate feedback. Methods: A low-cost, globally accessible, telemedicine simulator, developed at the Technion?Israel Institute of Technology, Haifa, Israel?was used. A previous study in the field of interventional cardiology, evaluating the efficacy of the simulator to enhanced learning via knowledge exams, presented promising results of average scores varying from 94% after training and 54% before training (n=20) with P<.001. Two independent experiments involving obstetrics and gynecology (Ob-Gyn) physicians and senior ultrasound sonographers, with 32 subjects, were conducted using a new interactive concept of the WOZ (Wizard of OZ) simulator platform. The contribution of an instructor to learning outcomes was evaluated by comparing students? knowledge before and after each interactive instructor-led session as well as after fully automated e-learning in the field of Ob-Gyn. Results from objective knowledge tests were analyzed using hypothesis testing and model fitting. Results: A significant advantage (P=.01) was found in favor of the WOZ training approach. Content type and training audience were not significant. Conclusions: This study evaluated the contribution of an integrated teaching environment using a computerized interactive simulator, with an instructor providing immediate Web-based immediate feedback to trainees. Involvement of an instructor in the simulation-based training process provided better learning outcomes that varied training content and trainee populations did not affect the overall learning gains. UR - http://mededu.jmir.org/2017/1/e8/ UR - http://dx.doi.org/10.2196/mededu.6312 UR - http://www.ncbi.nlm.nih.gov/pubmed/28432039 ID - info:doi/10.2196/mededu.6312 ER - TY - JOUR AU - Kleinert, Robert AU - Heiermann, Nadine AU - Plum, Sven Patrick AU - Wahba, Roger AU - Chang, De-Hua AU - Maus, Martin AU - Chon, Seung-Hun AU - Hoelscher, H. Arnulf AU - Stippel, Ludger Dirk PY - 2015/11/17 TI - Web-Based Immersive Virtual Patient Simulators: Positive Effect on Clinical Reasoning in Medical Education JO - J Med Internet Res SP - e263 VL - 17 IS - 11 KW - medical education KW - simulation KW - virtual patients KW - immersive N2 - Background: Clinical reasoning is based on the declarative and procedural knowledge of workflows in clinical medicine. Educational approaches such as problem-based learning or mannequin simulators support learning of procedural knowledge. Immersive patient simulators (IPSs) go one step further as they allow an illusionary immersion into a synthetic world. Students can freely navigate an avatar through a three-dimensional environment, interact with the virtual surroundings, and treat virtual patients. By playful learning with IPS, medical workflows can be repetitively trained and internalized. As there are only a few university-driven IPS with a profound amount of medical knowledge available, we developed a university-based IPS framework. Our simulator is free to use and combines a high degree of immersion with in-depth medical content. By adding disease-specific content modules, the simulator framework can be expanded depending on the curricular demands. However, these new educational tools compete with the traditional teaching Objective: It was our aim to develop an educational content module that teaches clinical and therapeutic workflows in surgical oncology. Furthermore, we wanted to examine how the use of this module affects student performance. Methods: The new module was based on the declarative and procedural learning targets of the official German medical examination regulations. The module was added to our custom-made IPS named ALICE (Artificial Learning Interface for Clinical Education). ALICE was evaluated on 62 third-year students. Results: Students showed a high degree of motivation when using the simulator as most of them had fun using it. ALICE showed positive impact on clinical reasoning as there was a significant improvement in determining the correct therapy after using the simulator. ALICE positively impacted the rise in declarative knowledge as there was improvement in answering multiple-choice questions before and after simulator use. Conclusions: ALICE has a positive effect on knowledge gain and raises students? motivation. It is a suitable tool for supporting clinical education in the blended learning context. UR - http://www.jmir.org/2015/11/e263/ UR - http://dx.doi.org/10.2196/jmir.5035 UR - http://www.ncbi.nlm.nih.gov/pubmed/26577020 ID - info:doi/10.2196/jmir.5035 ER - TY - JOUR AU - Tix, Nadine AU - Gießler, Paul AU - Ohnesorge-Radtke, Ursula AU - Spreckelsen, Cord PY - 2015/11/11 TI - Semantic Indexing of Medical Learning Objects: Medical Students' Usage of a Semantic Network JO - JMIR Medical Education SP - e16 VL - 1 IS - 2 KW - semantic net KW - usability evaluation KW - semantic indexing KW - learning objects KW - medical education N2 - Background: The Semantically Annotated Media (SAM) project aims to provide a flexible platform for searching, browsing, and indexing medical learning objects (MLOs) based on a semantic network derived from established classification systems. Primarily, SAM supports the Aachen emedia skills lab, but SAM is ready for indexing distributed content and the Simple Knowledge Organizing System standard provides a means for easily upgrading or even exchanging SAM?s semantic network. There is a lack of research addressing the usability of MLO indexes or search portals like SAM and the user behavior with such platforms. Objective: The purpose of this study was to assess the usability of SAM by investigating characteristic user behavior of medical students accessing MLOs via SAM. Methods: In this study, we chose a mixed-methods approach. Lean usability testing was combined with usability inspection by having the participants complete four typical usage scenarios before filling out a questionnaire. The questionnaire was based on the IsoMetrics usability inventory. Direct user interaction with SAM (mouse clicks and pages accessed) was logged. Results: The study analyzed the typical usage patterns and habits of students using a semantic network for accessing MLOs. Four scenarios capturing characteristics of typical tasks to be solved by using SAM yielded high ratings of usability items and showed good results concerning the consistency of indexing by different users. Long-tail phenomena emerge as they are typical for a collaborative Web 2.0 platform. Suitable but nonetheless rarely used keywords were assigned to MLOs by some users. Conclusions: It is possible to develop a Web-based tool with high usability and acceptance for indexing and retrieval of MLOs. SAM can be applied to indexing multicentered repositories of MLOs collaboratively. UR - http://mededu.jmir.org/2015/2/e16/ UR - http://dx.doi.org/10.2196/mededu.4479 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731860 ID - info:doi/10.2196/mededu.4479 ER - TY - JOUR AU - Torous, John AU - O'Connor, Ryan AU - Franzen, Jamie AU - Snow, Caitlin AU - Boland, Robert AU - Kitts, Robert PY - 2015/11/05 TI - Creating a Pilot Educational Psychiatry Website: Opportunities, Barriers, and NextSteps JO - JMIR Medical Education SP - e14 VL - 1 IS - 2 KW - Psychiatry KW - Internet KW - Online KW - Education KW - Website N2 - Background: While medical students and residents may be utilizing websites as online learning resources, medical trainees and educators now have the opportunity to create such educational websites and digital tools on their own. However, the process and theory of building educational websites for medical education have not yet been fully explored. Objective: To understand the opportunities, barriers, and process of creating a novel medical educational website. Methods: We created a pilot psychiatric educational website to better understand the options, opportunities, challenges, and processes involved in the creation of a psychiatric educational website. We sought to integrate visual and interactive Web design elements to underscore the potential of such Web technology. Results: A pilot website (PsychOnCall) was created to demonstrate the potential of Web technology in medical and psychiatric education. Conclusions: Creating an educational website is now technically easier than ever before, and the primary challenge no longer is technology but rather the creation, validation, and maintenance of information for such websites as well as translating text-based didactics into visual and interactive tools. Medical educators can influence the design and implementation of online educational resources through creating their own websites and engaging medical students and residents in the process. UR - http://mededu.jmir.org/2015/2/e14/ UR - http://dx.doi.org/10.2196/mededu.4580 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731837 ID - info:doi/10.2196/mededu.4580 ER - TY - JOUR AU - Janssen, Anna AU - Shaw, Tim AU - Goodyear, Peter PY - 2015/09/28 TI - Using Video Games to Enhance Motivation States in Online Education: Protocol for a Team-Based Digital Game JO - JMIR Res Protoc SP - e114 VL - 4 IS - 3 KW - digital games KW - medical education KW - online learning N2 - Background: Video and computer games for education have been of interest to researchers for several decades. Over the last half decade, researchers in the health sector have also begun exploring the value of this medium. However, there are still many gaps in the literature regarding the effective use of video and computer games in medical education, particularly in relation to how learners interact with the platform, and how the games can be used to enhance collaboration. Objective: The objective of the study is to evaluate a team-based digital game as an educational tool for engaging learners and supporting knowledge consolidation in postgraduate medical education. Methods: A mixed methodology will be used in order to establish efficacy and level of motivation provided by a team-based digital game. Second-year medical students will be recruited as participants to complete 3 matches of the game at spaced intervals, in 2 evenly distributed teams. Prior to playing the game, participants will complete an Internet survey to establish baseline data. After playing the game, participants will voluntarily complete a semistructured interview to establish motivation and player engagement. Additionally, metrics collected from the game platform will be analyzed to determine efficacy. Results: The research is in the preliminary stages, but thus far a total of 54 participants have been recruited into the study. Additionally, a content development group has been convened to develop appropriate content for the platform. Conclusions: Video and computer games have been demonstrated to have value for educational purposes. Significantly less research has addressed how the medium can be effectively utilized in the health sector. Preliminary data from this study would suggest there is an interest in games for learning in the medical student body. As such, it is beneficial to undertake further research into how these games teach and engage learners in order to evaluate their role in tertiary and postgraduate medical education in the future. UR - http://www.researchprotocols.org/2002/3/e114/ UR - http://dx.doi.org/10.2196/resprot.4016 UR - http://www.ncbi.nlm.nih.gov/pubmed/26416522 ID - info:doi/10.2196/resprot.4016 ER - TY - JOUR AU - Raupach, Tobias AU - Grefe, Clemens AU - Brown, Jamie AU - Meyer, Katharina AU - Schuelper, Nikolai AU - Anders, Sven PY - 2015/09/28 TI - Moving Knowledge Acquisition From the Lecture Hall to the Student Home: A Prospective Intervention Study JO - J Med Internet Res SP - e223 VL - 17 IS - 9 KW - knowledge KW - lecture KW - medical education KW - podcast KW - retention N2 - Background: Podcasts are popular with medical students, but the impact of podcast use on learning outcomes in undergraduate medical education has not been studied in detail. Objective: Our aim was to assess the impact of podcasts accompanied by quiz questions and lecture attendance on short- and medium-term knowledge retention. Methods: Students enrolled for a cardio-respiratory teaching module were asked to prepare for 10 specific lectures by watching podcasts and submitting answers to related quiz questions before attending live lectures. Performance on the same questions was assessed in a surprise test and a retention test. Results: Watching podcasts and submitting answers to quiz questions (versus no podcast/quiz use) was associated with significantly better test performance in all items in the surprise test and 7 items in the retention test. Lecture attendance (versus no attendance) was associated with higher test performance in 3 items and 1 item, respectively. In a linear regression analysis adjusted for age, gender, and overall performance levels, both podcast/quiz use and lecture attendance were significant predictors of student performance. However, the variance explained by podcast/quiz use was greater than the variance explained by lecture attendance in the surprise test (38.7% vs 2.2%) and retention test (19.1% vs 4.0%). Conclusions: When used in conjunction with quiz questions, podcasts have the potential to foster knowledge acquisition and retention over and above the effect of live lectures. UR - http://www.jmir.org/2015/9/e223/ UR - http://dx.doi.org/10.2196/jmir.3814 UR - http://www.ncbi.nlm.nih.gov/pubmed/26416467 ID - info:doi/10.2196/jmir.3814 ER - TY - JOUR AU - Zhu, Egui AU - Lilienthal, Anneliese AU - Shluzas, Aquino Lauren AU - Masiello, Italo AU - Zary, Nabil PY - 2015/09/18 TI - Design of Mobile Augmented Reality in Health Care Education: A Theory-Driven Framework JO - JMIR Medical Education SP - e10 VL - 1 IS - 2 KW - augmented reality KW - health care education KW - antibiotics KW - general practitioners KW - learning environment KW - learning theory KW - mobile technology N2 - Background: Augmented reality (AR) is increasingly used across a range of subject areas in health care education as health care settings partner to bridge the gap between knowledge and practice. As the first contact with patients, general practitioners (GPs) are important in the battle against a global health threat, the spread of antibiotic resistance. AR has potential as a practical tool for GPs to combine learning and practice in the rational use of antibiotics. Objective: This paper was driven by learning theory to develop a mobile augmented reality education (MARE) design framework. The primary goal of the framework is to guide the development of AR educational apps. This study focuses on (1) identifying suitable learning theories for guiding the design of AR education apps, (2) integrating learning outcomes and learning theories to support health care education through AR, and (3) applying the design framework in the context of improving GPs? rational use of antibiotics. Methods: The design framework was first constructed with the conceptual framework analysis method. Data were collected from multidisciplinary publications and reference materials and were analyzed with directed content analysis to identify key concepts and their relationships. Then the design framework was applied to a health care educational challenge. Results: The proposed MARE framework consists of three hierarchical layers: the foundation, function, and outcome layers. Three learning theories?situated, experiential, and transformative learning?provide foundational support based on differing views of the relationships among learning, practice, and the environment. The function layer depends upon the learners? personal paradigms and indicates how health care learning could be achieved with MARE. The outcome layer analyzes different learning abilities, from knowledge to the practice level, to clarify learning objectives and expectations and to avoid teaching pitched at the wrong level. Suggestions for learning activities and the requirements of the learning environment form the foundation for AR to fill the gap between learning outcomes and medical learners? personal paradigms. With the design framework, the expected rational use of antibiotics by GPs is described and is easy to execute and evaluate. The comparison of specific expected abilities with the GP personal paradigm helps solidify the GP practical learning objectives and helps design the learning environment and activities. The learning environment and activities were supported by learning theories. Conclusions: This paper describes a framework for guiding the design, development, and application of mobile AR for medical education in the health care setting. The framework is theory driven with an understanding of the characteristics of AR and specific medical disciplines toward helping medical education improve professional development from knowledge to practice. Future research will use the framework as a guide for developing AR apps in practice to validate and improve the design framework. UR - http://mededu.jmir.org/2015/2/e10/ UR - http://dx.doi.org/10.2196/mededu.4443 UR - http://www.ncbi.nlm.nih.gov/pubmed/27731839 ID - info:doi/10.2196/mededu.4443 ER -