@Article{info:doi/10.2196/62838, author="Gashi, Andi and Brodmann Maeder, Monika and Hennel, K. Eva", title="Making Medical Education Courses Visible: Theory-Based Development of a National Database", journal="JMIR Med Educ", year="2025", month="Apr", day="16", volume="11", pages="e62838", keywords="curriculum mapping", keywords="faculty development", keywords="competencies", keywords="database", keywords="medical education", abstract="Background: Medical education has undergone professionalization during the last decades, and internationally, educators are trained in specific medical education courses also known as ``train the trainer'' courses. As these courses have developed organically based on local needs, the lack of a general structure and terminology can confuse and hinder educators' information and development. The first aim of this study was to conduct a national search, analyze the findings, and provide a presentation of medical education courses based on international theoretical frameworks to support Swiss course providers and educators searching for courses. The second aim was to provide a blueprint for such a procedure to be used by the international audience. Objective: In this study, we devised a scholarly approach to sorting and presenting medical education courses to make their content accessible to medical educators. This approach is presented in detailed steps and our openly available exemplary database to make it serve as a blueprint for other settings. Methods: Following our constructivist paradigm, we examined content from medical education courses using a theory-informed inductive data approach. Switzerland served as an example, covering 4 languages and different approaches to medical education. Data were gathered through an online search and a nationwide survey with course providers. The acquired data and a concurrently developed keyword system to standardize course terminology are presented using Obsidian, a software that shows data networks. Results: Our iterative search included several strategies (web search, survey, provider enquiry, and snowballing) and yielded 69 courses in 4 languages, with varying terminology, target audiences, and providers. The database of courses is interactive and openly accessible. An open-access template database structure is also available. Conclusions: This study proposes a novel method for sorting and visualizing medical education courses and the competencies they cover to provide an easy-to-use database, helping medical educators' practical and scholarly development. Notably, our analysis identified a specific emphasis on undergraduate teaching settings, potentially indicating a gap in postgraduate educational offerings. This aspect could be pivotal for future curriculum development and resource allocation. Our method might guide other countries and health care professions, offering a straightforward means of cataloging and making information about medical education courses widely available and promotable. ", doi="10.2196/62838", url="https://mededu.jmir.org/2025/1/e62838" } @Article{info:doi/10.2196/64773, author="Mohd Kassim, Amiruddin Mohd and Azli Shah, Yusoff Sidi Muhammad and Lim, Yn Jane Tze and Mohd Daud, Iryani Tuti", title="Online-Based and Technology-Assisted Psychiatric Education for Trainees: Scoping Review", journal="JMIR Med Educ", year="2025", month="Apr", day="15", volume="11", pages="e64773", keywords="online learning", keywords="telepsychiatry", keywords="remote learning", keywords="virtual", keywords="training", keywords="education", keywords="psychiatry", keywords="trainees", keywords="residents", abstract="Background: The concept of online learning in medical education has been gaining traction, but whether it can accommodate the complexity of higher-level psychiatric training remains uncertain. Objective: This review aims to identify the various online-based and technology-assisted educational methods used in psychiatric training and to examine the outcomes in terms of trainees' knowledge, skills, and levels of confidence or preference in using such technologies. Methods: A comprehensive search was conducted in PubMed, Cochrane, PsycINFO, Scopus, and ERIC to identify relevant literature from 1991 until 2024. Studies in English and those that had English translations were identified. Studies that incorporated or explored the use of online-based or technology-assisted learning as part of psychiatric training in trainees and had outcomes of interest related to changes in the level of knowledge or skills, changes in the level of preference or confidence in using online-based or technology-assisted learning, and feedback of participants were included. Studies were excluded if they were conducted on populations excluding psychiatric trainees or residents, were mainly descriptive of the concept of the intervention without any relevant study outcome, were not in English or did not have English translations, or were review articles. Results: A total of 82 articles were included in the review. The articles were divided into 3 phases: prior to 2015, 2015 to 2019 (prepandemic), and 2020 onward (postpandemic). Articles mainly originated from Western countries, and there was a significant increase in relevant studies after the pandemic. There were 5 methods identified, namely videoconference, online modules/e-learning, virtual patients, software/applications, and social media. These were applied in various aspects of psychiatric education, such as theory knowledge, skills training, psychotherapy supervision, and information retrieval. Conclusions: Videoconference-based learning was the most widely implemented approach, followed by online modules and virtual patients. Despite the outcome heterogeneity and small sample sizes in the included studies, the application of such approaches may have utility in terms of knowledge and skills attainment and could be beneficial for the training of future psychiatrists, especially those in underserved low- and middle-income countries. ", doi="10.2196/64773", url="https://mededu.jmir.org/2025/1/e64773" } @Article{info:doi/10.2196/67883, author="Wei, Bin and Yao, Lili and Hu, Xin and Hu, Yuxiang and Rao, Jie and Ji, Yu and Dong, Zhuoer and Duan, Yichong and Wu, Xiaorong", title="Evaluating the Effectiveness of Large Language Models in Providing Patient Education for Chinese Patients With Ocular Myasthenia Gravis: Mixed Methods Study", journal="J Med Internet Res", year="2025", month="Apr", day="10", volume="27", pages="e67883", keywords="LLM", keywords="large language models", keywords="ocular myasthenia gravis", keywords="patient education", keywords="China", keywords="effectiveness", keywords="deep learning", keywords="artificial intelligence", keywords="health care", keywords="accuracy", keywords="applicability", keywords="neuromuscular disorder", keywords="extraocular muscles", keywords="ptosis", keywords="diplopia", keywords="ophthalmology", keywords="ChatGPT", keywords="clinical practice", keywords="digital health", abstract="Background: Ocular myasthenia gravis (OMG) is a neuromuscular disorder primarily affecting the extraocular muscles, leading to ptosis and diplopia. Effective patient education is crucial for disease management; however, in China, limited health care resources often restrict patients' access to personalized medical guidance. Large language models (LLMs) have emerged as potential tools to bridge this gap by providing instant, AI-driven health information. However, their accuracy and readability in educating patients with OMG remain uncertain. Objective: The purpose of this study was to systematically evaluate the effectiveness of multiple LLMs in the education of Chinese patients with OMG. Specifically, the validity of these models in answering patients with OMG-related questions was assessed through accuracy, completeness, readability, usefulness, and safety, and patients' ratings of their usability and readability were analyzed. Methods: The study was conducted in two phases: 130 choice ophthalmology examination questions were input into 5 different LLMs. Their performance was compared with that of undergraduates, master's students, and ophthalmology residents. In addition, 23 common patients with OMG-related patient questions were posed to 4 LLMs, and their responses were evaluated by ophthalmologists across 5 domains. In the second phase, 20 patients with OMG interacted with the 2 LLMs from the first phase, each asking 3 questions. Patients assessed the responses for satisfaction and readability, while ophthalmologists evaluated the responses again using the 5 domains. Results: ChatGPT o1-preview achieved the highest accuracy rate of 73\% on 130 ophthalmology examination questions, outperforming other LLMs and professional groups like undergraduates and master's students. For 23 common patients with OMG-related questions, ChatGPT o1-preview scored highest in correctness (4.44), completeness (4.44), helpfulness (4.47), and safety (4.6). GEMINI (Google DeepMind) provided the easiest-to-understand responses in readability assessments, while GPT-4o had the most complex responses, suitable for readers with higher education levels. In the second phase with 20 patients with OMG, ChatGPT o1-preview received higher satisfaction scores than Ernie 3.5 (Baidu; 4.40 vs 3.89, P=.002), although Ernie 3.5's responses were slightly more readable (4.31 vs 4.03, P=.01). Conclusions: LLMs such as ChatGPT o1-preview may have the potential to enhance patient education. Addressing challenges such as misinformation risk, readability issues, and ethical considerations is crucial for their effective and safe integration into clinical practice. ", doi="10.2196/67883", url="https://www.jmir.org/2025/1/e67883" } @Article{info:doi/10.2196/58542, author="Hylander, Johan and Gyllencreutz, Lina and Haney, Michael and Westman, Anton", title="Ambulance Commanders' Reluctance to Enter Road Tunnels in Simulated Incidents and the Effects of a Tunnel-Specific e-Learning Course on Decision-Making: Web-Based Randomized Controlled Trial", journal="JMIR Form Res", year="2025", month="Mar", day="28", volume="9", pages="e58542", keywords="e-learning", keywords="major incident", keywords="incident management", keywords="disaster medicine", keywords="road tunnels", abstract="Background: The optimal response to a major incident in a road tunnel involves efficient decision-making among the responding emergency services (fire and rescue services, police, and ambulances). The infrequent occurrence of road tunnel incidents may entail unfamiliarity with the tunnel environment and lead to uncertain and inefficient decision-making among emergency services commanders. Ambulance commanders have requested tunnel-specific learning materials to improve their preparedness. Objective: We aimed to assess decision-making among ambulance commanders in simulated road tunnel incidents after they had participated in a tunnel-specific e-learning course designed to support timely and correct decisions in this context. Methods: We conducted a web-based intervention study involving 20 participants from emergency medical services in Sweden who were randomly allocated to a test or control group. The control group (n=10, 50\%) received a lecture on general incident management, while the intervention group (n=10, 50\%) completed an e-learning course consisting of 5 modules focused on tunnel structure, safety, and collaboration in response. The participants took part in 2 simulation-based assessments for ambulance commander decision-making in major road tunnel incidents 1 month and 6 months after their allocated study intervention. In each simulation, the participants decided on the best course of action at 15 independent decision points, designed as multiple-choice questions. The primary outcome was the correct response to the question regarding how to appropriately enter the road tunnel. The secondary outcome measurements were correct or incorrect responses and the time taken to decide for each of the 15 decisions. Limited in-depth follow-up interviews were conducted with participants (n=5, 25\%), and collected data were analyzed using qualitative content analysis. Results: All 20 participants completed the first simulation, and 16 (80\%) completed the second. The main finding was that none (0/20, 0\%) of the participants correctly answered the question on entering the tunnel system in the 1-month assessment. There were no significant differences between the groups (P=.59; 2-sample test of proportions) in the second assessment. The e-learning course was not associated with more correct answers at the first assessment, including accounting for participant factors (mean difference between groups: --0.58 points, 95\% CI --1.88 to 0.73; P=.36). The e-learning course was also not associated with a shorter time to completion compared to the nonintervention group in either assessment. Interviews identified 3 categories linked to the main outcome: information (lack of), risk (limited knowledge and equipment), and mitigation (access to maps and aide-m{\'e}moire). Conclusions: Participation in a tunnel-specific e-learning course did not result in a measurable change in ambulance commanders' decision-making behavior during simulated road tunnel incidents. The observed hesitation to enter the road tunnel system may have several plausible causes, such as the lack of actionable intelligence and tunnel-specific plans. This novel approach to assessing commander decision-making may be transferable to other educational settings. ", doi="10.2196/58542", url="https://formative.jmir.org/2025/1/e58542" } @Article{info:doi/10.2196/64768, author="Zainal, Humairah and Xiao Hui, Xin and Thumboo, Julian and Kok Yong, Fong", title="Organizational Leaders' Views on Digital Health Competencies in Medical Education: Qualitative Semistructured Interview Study", journal="JMIR Med Educ", year="2025", month="Mar", day="7", volume="11", pages="e64768", keywords="technology", keywords="medical education", keywords="curriculum", keywords="clinical competence", keywords="digital competence", keywords="Singapore", keywords="digital health", keywords="qualitative study", keywords="medical school", keywords="risk", keywords="comprehensive framework", keywords="doctor", keywords="thematic analysis", keywords="information technology", keywords="evidence-based", keywords="undergraduate", keywords="healthcare systems", keywords="mobile phone", abstract="Background: Digital technologies (DTs) have profoundly impacted health care delivery globally and are increasingly used in clinical practice. Despite this, there is a scarcity of guidelines for implementing training in digital health competencies (DHC) in medical schools, especially for clinical practice. A lack of sustained integration of DHC risks creating knowledge gaps due to a limited understanding of how DT should be used in health care. Furthermore, few studies have explored reasons for this lag, both within and beyond the medical school curriculum. Current frameworks to address these barriers are often specific to individual countries or schools and focus primarily on curriculum design and delivery. A comprehensive framework is therefore required to ensure consistent implementation of DHC across various contexts and times. Objective: This study aims to use Singapore as a case study and examine the perspectives of doctors in organizational leadership positions to identify and analyze the barriers to DHC implementation in the undergraduate curriculum of Singapore's medical schools. It also seeks to apply the Normalization Process Theory (NPT) to address these barriers and bridge the gap between health care systems and digital health education (DHE) training. Methods: Individual semistructured interviews were conducted with doctors in executive and organizational leadership roles. Participants were recruited through purposive sampling, and the data were interpreted using qualitative thematic analysis. Results: A total of 33 doctors participated, 26 of whom are currently in organizational leadership roles and 7 of whom have previously held such positions. A total of 6 barriers were identified: bureaucratic inertia, lack of opportunities to pursue nontraditional career pathways, limited protective mechanisms for experiential learning and experimentation, lack of clear policy guidelines for clinical practice, insufficient integration between medical school education and clinical experience, and poor IT integration within the health care industry. Conclusions: These barriers are also present in other high-income countries experiencing health care digitalization, highlighting the need for a theoretical framework that broadens the generalizability of existing recommendations. Applying the NPT underscores the importance of addressing these barriers to effectively integrate DHC into the curriculum. The active involvement of multiple stakeholders and the incorporation of continuous feedback mechanisms are essential. Our proposed framework provides concrete, evidence-based, and step-by-step recommendations for implementation practice, supporting the introduction of DHC in undergraduate medical education. ", doi="10.2196/64768", url="https://mededu.jmir.org/2025/1/e64768", url="http://www.ncbi.nlm.nih.gov/pubmed/40053774" } @Article{info:doi/10.2196/67993, author="Katta, Sravya and Davoody, Nadia", title="Exploring Health Care Professionals' Perspectives on Education, Awareness, and Preferences for Digital Educational Resources to Support Transgender, Nonbinary, and Intersex Care: Interview Study", journal="JMIR Med Educ", year="2025", month="Mar", day="6", volume="11", pages="e67993", keywords="health care professionals", keywords="transgender, nonbinary, and intersex", keywords="communication challenges", keywords="systematic barriers", keywords="information and communication technology", abstract="Background: Health care professionals often face challenges in providing affirming and culturally competent care to transgender, nonbinary, and intersex (TNBI) patients due to a lack of understanding and training in TNBI health care. This gap highlights the opportunity for tailored educational resources to enhance health care professionals' interactions with TNBI individuals. Objective: This study aimed to explore health care professionals' perspectives on education and awareness of health issues related to TNBI individuals. Specifically, it aimed to identify their needs, challenges, and preferences in accessing and using digital educational resources to enhance their knowledge and competence in providing inclusive and effective care for this population. Methods: A qualitative research approach was used in this study. In total, 15 health care professionals were recruited via convenience sampling to participate in semistructured interviews. Thematic analysis was applied to identify recurring codes and themes. Results: The study identified several themes and subthemes related to gender diversity awareness, inclusive communication and understanding the needs of TNBI individuals, societal and structural challenges, regulatory gaps in training and support infrastructure, education and training needs for health care professionals on TNBI care, educational resources and training tools for TNBI care, challenges and design considerations for eHealth tools integrations, and evaluating eHealth impact. Participants identified communication barriers, the need for health care providers to use inclusive language, and gaps in both health care system infrastructure and specialized training for gender-affirming care. In addition, participants expressed a need for comprehensive education on transgender and nonbinary health issues, resources for mental health professionals, user-friendly design, and accessibility features in eHealth tools. Conclusions: The study revealed substantial deficiencies in health care professionals' knowledge of gender diversity, cultural competency, and the importance of inclusive communication. Addressing the identified barriers and challenges through targeted interventions, such as providing training and support for health care professionals, investing in user-friendly design and data security, and promoting cultural competence in TNBI health care, is essential. Despite integration challenges, eHealth tools have the potential to improve patient--health care professional relationships and access to care. ", doi="10.2196/67993", url="https://mededu.jmir.org/2025/1/e67993", url="http://www.ncbi.nlm.nih.gov/pubmed/40053815" } @Article{info:doi/10.2196/58100, author="Briggs, Blake and Mulekar, Madhuri and Morales, Hannah and Husain, Iltifat", title="Comparison of an Emergency Medicine Asynchronous Learning Platform Usage Before and During the COVID-19 Pandemic: Retrospective Analysis Study", journal="JMIR Med Educ", year="2025", month="Feb", day="21", volume="11", pages="e58100", keywords="asynchronous learning", keywords="medical education", keywords="podcast", keywords="COVID-19", keywords="emergency medicine", keywords="online learning", keywords="engagement", keywords="web-based", keywords="online study", keywords="online class", keywords="videoconferencing", keywords="assessment", keywords="effectiveness", keywords="challenges", keywords="knowledge retention", keywords="performance", keywords="virtual learning", keywords="pre-pandemic", keywords="post-pandemic", abstract="Background: The COVID-19 pandemic challenged medical educators due to social distancing. Podcasts and asynchronous learning platforms help distill medical education in a socially distanced environment. Medical educators interested in providing asynchronous teaching should know how these methods performed during the pandemic. Objective: The purpose of this study was to assess the level of engagement for an emergency medicine (EM) board review podcast and website platform, before and during the COVID-19 pandemic. We measured engagement via website traffic, including such metrics as visits, bounce rate, unique visitors, and page views. We also evaluated podcast analytics, which included total listeners, engaged listeners, and number of plays. Methods: Content was designed after the American Board of EM Model, covering only 1 review question per episode. Website traffic and podcast analytics were studied monthly from 2 time periods of 20 months each, before the pandemic (July 11, 2018, to February 31, 2020) and during the pandemic (May 1, 2020, to December 31, 2021). March and April 2020 data were omitted from the analysis due to variations in closure at various domestic and international locations. Results underwent statistical analysis in March 2022. Results: A total of 132 podcast episodes and 93 handouts were released from July 11, 2018, to December 31, 2021. The mean number of listeners per podcast increased significantly from 2.11 (SD 1.19) to 3.77 (SD 0.76; t test, P<.001), the mean number engaged per podcast increased from 1.72 (SD 1.00) to 3.09 (SD 0.62; t test, P<.001), and the mean number of plays per podcast increased from 42.54 (SD 40.66) to 69.23 (SD 17.54; t test, P=.012). Similarly, the mean number of visits per posting increased from 5.85 (SD 3.28) to 15.39 (SD 3.06; t test, P<.001), the mean number of unique visitors per posting increased from 3.74 (SD 1.83) to 10.41 (SD 2.33; t test, P<.001), and the mean number of page views per posting increased from 17.13 (SD 10.63) to 33.32 (SD 7.01; t test, P<.001). Note that, all measures showed a decrease from November 2021 to December 2021. Conclusions: During the COVID-19 pandemic, there was an increased engagement for our EM board review podcast and website platform over a long-term period, specifically through website visitors and the number of podcast plays. Medical educators should be aware of the increasing usage of web-based education tools, and that asynchronous learning is favorably viewed by learners. Limitations include the inability to view Spotify (Spotify Technology S.A.) analytics during the study period, and confounding factors like increased popularity of social media inadvertently promoting the podcast. ", doi="10.2196/58100", url="https://mededu.jmir.org/2025/1/e58100" } @Article{info:doi/10.2196/55861, author="Escamilla-Sanchez, Alejandro and L{\'o}pez-Villodres, Antonio Juan and Alba-Tercedor, Carmen and Ortega-Jim{\'e}nez, Victoria Mar{\'i}a and Rius-D{\'i}az, Francisca and Sanchez-Varo, Raquel and Berm{\'u}dez, Diego", title="Instagram as a Tool to Improve Human Histology Learning in Medical Education: Descriptive Study", journal="JMIR Med Educ", year="2025", month="Feb", day="19", volume="11", pages="e55861", keywords="medical education", keywords="medical students", keywords="histology", keywords="pathology", keywords="e-learning", keywords="computer-based", keywords="social media", keywords="Instagram", keywords="Meta", keywords="community-oriented", keywords="usability", keywords="utility", keywords="accessibility", abstract="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. ", doi="10.2196/55861", url="https://mededu.jmir.org/2025/1/e55861" } @Article{info:doi/10.2196/64550, author="Rivera Garc{\'i}a, Esmeralda Guadalupe and Cervantes L{\'o}pez, Janet Miriam and Ram{\'i}rez V{\'a}zquez, Carlos Juan and Llanes Castillo, Arturo and Cruz Casados, Jaime", title="Reviewing Mobile Apps for Teaching Human Anatomy: Search and Quality Evaluation Study", journal="JMIR Med Educ", year="2025", month="Feb", day="14", volume="11", pages="e64550", keywords="anatomy", keywords="Google Play", keywords="mobile health", keywords="mHealth", keywords="Mobile App Rating Scale", keywords="MARS", abstract="Background: Mobile apps designed for teaching human anatomy offer a flexible, interactive, and personalized learning platform, enriching the educational experience for both students and health care professionals. Objective: This study aimed to conduct a systematic review of the human anatomy mobile apps available on Google Play, evaluate their quality, highlight the highest scoring apps, and determine the relationship between objective quality ratings and subjective star ratings. Methods: The Mobile App Rating Scale (MARS) was used to evaluate the apps. The intraclass correlation coefficient was calculated using a consistency-type 2-factor random model to measure the reliability of the evaluations made by the experts. In addition, Pearson correlations were used to analyze the relationship between MARS quality scores and subjective evaluations of MARS quality item 23. Results: The mobile apps with the highest overall quality scores according to the MARS (ie, sections A, B, C, and D) were Organos internos 3D (anatom{\'i}a) (version 4.34), Sistema {\'o}seo en 3D (Anatom{\'i}a) (version 4.32), and VOKA Anatomy Pro (version 4.29). To measure the reliability of the MARS quality evaluations (sections A, B, C, and D), the intraclass correlation coefficient was used, and the result was ``excellent.'' Finally, Pearson correlation results revealed a significant relationship (r=0.989; P<.001) between the quality assessments conducted by health care professionals and the subjective evaluations of item 23. Conclusions: The average evaluation results of the selected apps indicated a ``good'' level of quality, and those with the highest ratings could be recommended. However, the lack of scientific backing for these technological tools is evident. It is crucial that research centers and higher education institutions commit to the active development of new mobile health apps, ensuring their accessibility and validation for the general public. ", doi="10.2196/64550", url="https://mededu.jmir.org/2025/1/e64550" } @Article{info:doi/10.2196/68743, author="Shikino, Kiyoshi and Yamauchi, Kazuyo and Araki, Nobuyuki and Shimizu, Ikuo and Kasai, Hajime and Tsukamoto, Tomoko and Tajima, Hiroshi and Li, Yu and Onodera, Misaki and Ito, Shoichi", title="Understanding Community Health Care Through Problem-Based Learning With Real-Patient Videos: Single-Arm Pre-Post Mixed Methods Study", journal="JMIR Med Educ", year="2025", month="Jan", day="31", volume="11", pages="e68743", keywords="community health care", keywords="community-oriented medical education", keywords="mixed method", keywords="problem-based learning", keywords="real-patient video", abstract="Background: Japan faces a health care delivery challenge due to physician maldistribution, with insufficient physicians practicing in rural areas. This issue impacts health care access in remote areas and affects patient outcomes. Educational interventions targeting students' career decision-making can potentially address this problem by promoting interest in rural medicine. We hypothesized that community-based problem-based learning (PBL) using real-patient videos could foster students' understanding of community health care and encourage positive attitudes toward rural health care. Objective: This study investigated the impact of community-based PBL on medical students' understanding and engagement with rural health care, focusing on their knowledge, skills, and career orientation. Methods: Participants were 113 fourth-year medical students from Chiba University, engaged in a transition course between preclinical and clinical clerkships from October 24 to November 2, 2023. The students were randomly divided into 16 groups (7-8 participants per group). Each group participated in two 3-hour PBL sessions per week over 2 consecutive weeks. Quantitative data were collected using pre- and postintervention questionnaires, comprehension tests, and tutor-assessed rubrics. Self-assessment questionnaires evaluated the students' interest in community health care and their ability to envision community health care settings before and after the intervention. Qualitative data from the students' semistructured interviews after the PBL sessions assessed the influence of PBL experience on clinical clerkship in community hospitals. Statistical analysis included median (IQR), effect sizes, and P values for quantitative outcomes. Thematic analysis was used for qualitative data. Results: Of the 113 participants, 71 (62.8\%) were male and 42 (37.2\%) female. The total comprehension test scores improved significantly (pretest: median 4.0, IQR 2.5-5.0; posttest: median 5, IQR 4-5; P<.001; effect size r=0.528). Rubric-based assessments showed increased knowledge application (pretest: median 8, IQR 7-9; posttest: median 8, IQR 8-8; P<.001; r=0.494) and self-directed learning (pretest: median 8, IQR 7-9; posttest: median 8, IQR 8-8; P<.001; r=0.553). Self-assessment questionnaires revealed significant improvements in the students' interest in community health care (median 3, IQR 3-4 to median 4, IQR 3-4; P<.001) and their ability to envision community health care settings (median 3, IQR 3-4 to median 4, IQR 3-4; P<.001). Thematic analysis revealed key themes, such as ``empathy in patient care,'' ``challenges in home health care,'' and ``professional identity formation.'' Conclusions: Community-based PBL with real-patient videos effectively enhances medical students' understanding of rural health care settings, clinician roles, and the social needs of rural patients. This approach holds potential as an educational strategy to address physician maldistribution. Although this study suggests potential for fostering positive attitudes toward rural health care, further research is needed to assess its long-term impact on students' career trajectories. ", doi="10.2196/68743", url="https://mededu.jmir.org/2025/1/e68743" } @Article{info:doi/10.2196/58108, author="Celdr{\'a}n, Javier Francisco and Jim{\'e}nez-Ruescas, Javier and Lobato, Carlos and Salazar, Luc{\'i}a and S{\'a}nchez-Margallo, Alberto Juan and S{\'a}nchez-Margallo, M. Francisco and Gonz{\'a}lez, Pascual", title="Use of Augmented Reality for Training Assistance in Laparoscopic Surgery: Scoping Literature Review", journal="J Med Internet Res", year="2025", month="Jan", day="28", volume="27", pages="e58108", keywords="laparoscopic surgery", keywords="surgical training", keywords="surgical simulator", keywords="augmented reality--based laparoscopic simulator", keywords="AR-based laparoscopic simulator", keywords="augmented reality", keywords="mobile phone", abstract="Background: Laparoscopic surgery training is a demanding process requiring technical and nontechnical skills. Surgical training has evolved from traditional approaches to the use of immersive digital technologies such as virtual, augmented, and mixed reality. These technologies are now integral to laparoscopic surgery training. Objective: This scoping literature review aimed to analyze the current augmented reality (AR) solutions used in laparoscopic surgery training. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a scoping review using 4 databases: Scopus, IEEE Xplore, PubMed, and ACM. Inclusion and exclusion criteria were applied to select relevant articles. Exclusion criteria were studies not using AR, not focused on laparoscopic surgery, not focused on training, written in a language other than English, or not providing relevant information on the topics studied. After selecting the articles, research questions (RQs) were formulated to guide the review. In total, 2 independent reviewers then extracted relevant data, and a descriptive analysis of the results was conducted. Results: Of 246 initial records, 172 (69.9\%) remained after removing duplicates. After applying the exclusion criteria, 76 articles were selected, with 25 (33\%) later excluded for not meeting quality standards, leaving 51 (67\%) in the final review. Among the devices analyzed (RQ 1), AR video--based devices were the most prevalent (43/51, 84\%). The most common information provided by AR devices (RQ 1) focused on task execution and patient-related data, both appearing in 20\% (10/51) of studies. Regarding sensorization (RQ 2), most studies (46/51, 90\%) incorporated some form of sensorized environment, with computer vision being the most used technology (21/46, 46\%) and the trainee the most frequently sensorized element (41/51, 80\%). Regarding training setups (RQ 3), 39\% (20/51) of the studies used commercial simulators, and 51\% (26/51) made use of artificial models. Concerning the evaluation methods (RQ 4), objective evaluation was the most used, featured in 71\% (36/51) of the studies. Regarding tasks (RQ 5), 43\% (22/51) of studies focused on full surgical procedures, whereas 57\% (29/51) focused on simple training tasks, with suturing being the most common among the latter (11/29, 38\%). Conclusions: This scoping review highlights the evolving role of AR technologies in laparoscopic surgery training, although the impact of optical see-through devices remains unclear due to their limited use. It underscores the potential of emerging technologies such as haptic feedback, computer vision, and eye tracking to further enhance laparoscopic skill acquisition. While most relevant articles from other databases were included, some studies may have been missed due to the specific databases and search strategies used. Moreover, the need for standardized evaluation metrics is emphasized, paving the way for future research into AR's full potential in laparoscopic skill acquisition. ", doi="10.2196/58108", url="https://www.jmir.org/2025/1/e58108" } @Article{info:doi/10.2196/63241, author="Baetzner, Sabine Anke and Hill, Yannick and Roszipal, Benjamin and Gerwann, Sol{\`e}ne and Beutel, Matthias and Birrenbach, Tanja and Karlseder, Markus and Mohr, Stefan and Salg, Alexander Gabriel and Schrom-Feiertag, Helmut and Frenkel, Ottilie Marie and Wrzus, Cornelia", title="Mass Casualty Incident Training in Immersive Virtual Reality: Quasi-Experimental Evaluation of Multimethod Performance Indicators", journal="J Med Internet Res", year="2025", month="Jan", day="27", volume="27", pages="e63241", keywords="prehospital decision-making", keywords="disaster medicine", keywords="emergency medicine", keywords="mass casualty incident", keywords="medical education", keywords="eye tracking", keywords="emergency simulation", keywords="virtual reality", abstract="Background: Immersive virtual reality (iVR) has emerged as a training method to prepare medical first responders (MFRs) for mass casualty incidents (MCIs) and disasters in a resource-efficient, flexible, and safe manner. However, systematic evaluations and validations of potential performance indicators for virtual MCI training are still lacking. Objective: This study aimed to investigate whether different performance indicators based on visual attention, triage performance, and information transmission can be effectively extended to MCI training in iVR by testing if they can discriminate between different levels of expertise. Furthermore, the study examined the extent to which such objective indicators correlate with subjective performance assessments. Methods: A total of 76 participants (mean age 25.54, SD 6.01 y; 45/76, 59\% male) with different medical expertise (MFRs: paramedics and emergency physicians; non-MFRs: medical students, in-hospital nurses, and other physicians) participated in 5 virtual MCI scenarios of varying complexity in a randomized order. Tasks involved assessing the situation, triaging virtual patients, and transmitting relevant information to a control center. Performance indicators included eye-tracking--based visual attention, triage accuracy, triage speed, information transmission efficiency, and self-assessment of performance. Expertise was determined based on the occupational group (39/76, 51\% MFRs vs 37/76, 49\% non-MFRs) and a knowledge test with patient vignettes. Results: Triage accuracy (d=0.48), triage speed (d=0.42), and information transmission efficiency (d=1.13) differentiated significantly between MFRs and non-MFRs. In addition, higher triage accuracy was significantly associated with higher triage knowledge test scores (Spearman $\rho$=0.40). Visual attention was not significantly associated with expertise. Furthermore, subjective performance was not correlated with any other performance indicator. Conclusions: iVR-based MCI scenarios proved to be a valuable tool for assessing the performance of MFRs. The results suggest that iVR could be integrated into current MCI training curricula to provide frequent, objective, and potentially (partly) automated performance assessments in a controlled environment. In particular, performance indicators, such as triage accuracy, triage speed, and information transmission efficiency, capture multiple aspects of performance and are recommended for integration. While the examined visual attention indicators did not function as valid performance indicators in this study, future research could further explore visual attention in MCI training and examine other indicators, such as holistic gaze patterns. Overall, the results underscore the importance of integrating objective indicators to enhance trainers' feedback and provide trainees with guidance on evaluating and reflecting on their own performance. ", doi="10.2196/63241", url="https://www.jmir.org/2025/1/e63241" } @Article{info:doi/10.2196/66109, author="Walzer, Stefan and Barthel, Carolin and Pazouki, Ronja and Marx, Helga and Ziegler, Sven and Koenig, Peter and Kugler, Christiane and Jobst, Stefan", title="Teaching in the Digital Age---Developing a Support Program for Nursing Education Providers: Design-Based Research", journal="JMIR Form Res", year="2025", month="Jan", day="15", volume="9", pages="e66109", keywords="digital competencies", keywords="nursing education", keywords="support program", keywords="needs assessment", keywords="design-based research", keywords="feasibility study", keywords="nursing education provider", keywords="qualitative research", keywords="nurse", keywords="health care", keywords="focus group", keywords="digital age", keywords="expert consultation", keywords="thematic content analysis", keywords="feasibility test", keywords="satisfaction", keywords="competency-based approach", keywords="workplace barrier", keywords="health care digitalization", keywords="digital technology", abstract="Background: Health care systems and the nursing profession worldwide are being transformed by technology and digitalization. Nurses acquire digital competence through their own experience in daily practice, but also from education and training; nursing education providers thus play an important role. While nursing education providers have some level of digital competence, there is a need for ongoing training and support for them to develop more advanced skills and effectively integrate technology into their teaching. Objective: This study aims to develop a needs-based support program for nursing education providers to foster digital competencies and to test this intervention. Methods: We used a design-based research approach, incorporating iterative development with expert consultation to create and evaluate a support program for nursing education providers. Focus groups were conducted online to assess needs, and thematic content analysis was used to derive key insights. The support program was then refined through expert feedback and subjected to a feasibility and satisfaction test, with participant evaluations analyzed descriptively. Results: Six main categories emerged from the focus groups, highlighting key areas, including the use of digital technology, ongoing support needs, and the current state of digitalization in nursing education. The support program was developed based on these findings, with expert validation leading to adjustments in timing, content prioritization, and platform integration. Preliminary testing showed good overall satisfaction with the support program, although participants suggested improvements in content relevance and digital platform usability. Conclusions: Although the feasibility test showed high satisfaction with the support program, low participation rates and limited perceived knowledge gain were major concerns. The results suggest that while the program was well received, further refinements, including a focus on competency-based approaches and addressing workplace barriers, are needed to increase participation and effectiveness of such interventions. The findings of this research can be used as a basis for the development of similar programs in other educational and health care contexts. ", doi="10.2196/66109", url="https://formative.jmir.org/2025/1/e66109" } @Article{info:doi/10.2196/64548, author="Nowell, Lorelli and Johnston, Sonja and Dolan, Sara and Jacobsen, Michele and Lorenzetti, L. Diane and Oddone Paolucci, Elizabeth", title="Exploring Educators' Perceptions and Experiences of Online Teaching to Foster Caring Profession Students' Development of Virtual Caring Skills: Sequential Explanatory Mixed Methods Study", journal="JMIR Nursing", year="2025", month="Jan", day="15", volume="8", pages="e64548", keywords="health care education", keywords="virtual care", keywords="telehealth", keywords="online teaching", keywords="mixed methods study", keywords="student", keywords="teaching", keywords="virtual caring skills", keywords="cross-sectional survey", keywords="interview", abstract="Background: Professionals in caring disciplines have been pivotal in advancing virtual care, which leverages remote technologies to deliver effective support and services from a distance. Educators in these caring professions are required to teach students the skills and competencies needed to provide high-quality and effective care. As virtual care becomes more integral, educators must equip students in these fields with both interpersonal and technological skills, bridging traditional hands-on learning with digital literacy. However, there is a gap in evidence exploring educators' perceptions and experiences of teaching caring profession students about virtual caring skills within online environments. Objective: This study aims to better understand caring profession educators' online teaching experiences to foster student development of virtual caring skills and competencies. Methods: We used a sequential explanatory mixed methods approach that integrated a cross-sectional survey and individual interviews with educators from caring professions to better understand caring professional educators' online teaching experiences to foster student development of virtual caring skills and competencies. The survey's primary objectives were to examine the various elements of existing e-learning opportunities, delve into educators' perspectives and encounters with these opportunities, and identify the factors that either facilitated or hindered online teaching practices to support students in developing virtual caring skills and competencies. The individual interview guides were based on survey findings and a systematic review of the evidence to gain deeper insights into educators' experiences and perspectives. Results: A total of 82 survey participants and 8 interview participants were drawn from educators in the fields of education, medicine, nursing, and social work. Various instructional methods were used to help students develop virtual caring skills, including reflections on learning, online modules, online discussion boards, demonstrations of remote care, and consultation with clients. There was a statistically significant difference between educators' level of experience teaching online and their satisfaction with online teaching and learning technologies (P<.001) and between educators' faculties (departments) and their satisfaction with online teaching and learning technologies (P=.001). Participants identified barriers (time constraints, underdeveloped curriculum, decreased student engagement, and limited access to virtual caring equipment and technology), facilitators (clearly defined learning objectives, technology software and support, teaching support, stakeholder engagement, and flexibility), and principles of teaching virtual caring skills in online environments (connection, interaction, compassion, empathy, care, and vulnerability). Conclusions: Our study identifies the barriers, facilitators, and principles in teaching virtual caring skills, offering practical strategies for educators in caring professions. This study contributes to the growing body of educational research on virtual caring skills by offering educator insights and suggestions for improved teaching and learning strategies in caring professions' programs. As educational practices evolve, future research should explore how traditionally in-person educators can effectively teach virtual caring skills across diverse contexts. ", doi="10.2196/64548", url="https://nursing.jmir.org/2025/1/e64548", url="http://www.ncbi.nlm.nih.gov/pubmed/39608377" } @Article{info:doi/10.2196/54152, author="Dushyanthen, Sathana and Zamri, Izzati Nadia and Chapman, Wendy and Capurro, Daniel and Lyons, Kayley", title="Evaluation of an Interdisciplinary Educational Program to Foster Learning Health Systems: Education Evaluation", journal="JMIR Med Educ", year="2025", month="Jan", day="14", volume="11", pages="e54152", keywords="continuing professional development", keywords="learning health system", keywords="flipped classroom", keywords="digital health informatics", keywords="data science", keywords="health professions education", keywords="interdisciplinary education", keywords="foster", keywords="foster learning", keywords="health data", keywords="design", keywords="innovative", keywords="innovative solution", keywords="health care workforce", keywords="Australia", keywords="real time", keywords="teaching model", abstract="Background: Learning health systems (LHS) have the potential to use health data in real time through rapid and continuous cycles of data interrogation, implementing insights to practice, feedback, and practice change. However, there is a lack of an appropriately skilled interprofessional informatics workforce that can leverage knowledge to design innovative solutions. Therefore, there is a need to develop tailored professional development training in digital health, to foster skilled interprofessional learning communities in the health care workforce in Australia. Objective: This study aimed to explore participants' experiences and perspectives of participating in an interprofessional education program over 13 weeks. The evaluation also aimed to assess the benefits, barriers, and opportunities for improvements and identify future applications of the course materials. Methods: We developed a wholly online short course open to interdisciplinary professionals working in digital health in the health care sector. In a flipped classroom model, participants (n=400) undertook 2 hours of preclass learning online and then attended 2.5 hours of live synchronous learning in interactive weekly Zoom workshops for 13 weeks. Throughout the course, they collaborated in small, simulated learning communities (n=5 to 8), engaging in various activities and problem-solving exercises, contributing their unique perspectives and diverse expertise. The course covered a number of topics including background on LHS, establishing learning communities, the design thinking process, data preparation and machine learning analysis, process modeling, clinical decision support, remote patient monitoring, evaluation, implementation, and digital transformation. To evaluate the purpose of the program, we undertook a mixed methods evaluation consisting of pre- and postsurveys rating scales for usefulness, engagement, value, and applicability for various aspects of the course. Participants also completed identical measures of self-efficacy before and after (n=200), with scales mapped to specific skills and tasks that should have been achievable following each of the topics covered. Further, they undertook voluntary weekly surveys to provide feedback on which aspects to continue and recommendations for improvements, via free-text responses. Results: From the evaluation, it was evident that participants found the teaching model engaging, useful, valuable, and applicable to their work. In the self-efficacy component, we observed a significant increase (P<.001) in perceived confidence for all topics, when comparing pre- and postcourse ratings. Overall, it was evident that the program gave participants a framework to organize their knowledge and a common understanding and shared language to converse with other disciplines, changed the way they perceived their role and the possibilities of data and technologies, and provided a toolkit through the LHS framework that they could apply in their workplaces. Conclusions: We present a program to educate the health workforce on integrating the LHS model into standard practice. Interprofessional collaborative learning was a major component of the value of the program. This evaluation shed light on the multifaceted challenges and expectations of individuals embarking on a digital health program. Understanding the barriers and facilitators of the audience is crucial for creating an inclusive and supportive learning environment. Addressing these challenges will not only enhance participant engagement but also contribute to the overall success of the program and, by extension, the broader integration of digital health solutions into health care practice and, ultimately, patient outcomes. ", doi="10.2196/54152", url="https://mededu.jmir.org/2025/1/e54152" } @Article{info:doi/10.2196/59720, author="Nicolau, Abel and Jorge, In{\^e}s and Vieira-Marques, Pedro and Sa-Couto, Carla", title="Influence of Training With Corrective Feedback Devices on Cardiopulmonary Resuscitation Skills Acquisition and Retention: Systematic Review and Meta-Analysis", journal="JMIR Med Educ", year="2024", month="Dec", day="19", volume="10", pages="e59720", keywords="cardiopulmonary resuscitation", keywords="CPR quality", keywords="resuscitation training", keywords="corrective feedback devices", keywords="skills acquisition", keywords="skills retention", keywords="systematic review", keywords="evidence-based research", keywords="meta-analysis", keywords="feedback devices", keywords="PRISMA", abstract="Background: Several studies related to the use of corrective feedback devices in cardiopulmonary resuscitation training, with different populations, training methodologies, and equipment, present distinct results regarding the influence of this technology. Objective: This systematic review and meta-analysis aimed to examine the impact of corrective feedback devices in cardiopulmonary resuscitation skills acquisition and retention for laypeople and health care professionals. Training duration was also studied. Methods: The search was conducted in PubMed, Web of Science, and Scopus from January 2015 to December 2023. Eligible randomized controlled trials compared technology-based training incorporating corrective feedback with standard training. Outcomes of interest were the quality of chest compression--related components. The risk of bias was assessed using the Cochrane tool. A meta-analysis was used to explore the heterogeneity of the selected studies. Results: In total, 20 studies were included. Overall, it was reported that corrective feedback devices used during training had a positive impact on both skills acquisition and retention. Medium to high heterogeneity was observed. Conclusions: This systematic review and meta-analysis suggest that corrective feedback devices enhance skills acquisition and retention over time. Considering the medium to high heterogeneity observed, these findings should be interpreted with caution. More standardized, high-quality studies are needed. Trial Registration: PROSPERO CRD42021240953; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=240953 ", doi="10.2196/59720", url="https://mededu.jmir.org/2024/1/e59720", url="http://www.ncbi.nlm.nih.gov/pubmed/39699935" } @Article{info:doi/10.2196/57327, author="Sun, Wan-Na and Hsieh, Min-Chai and Wang, Wei-Fang", title="Nurses' Knowledge and Skills After Use of an Augmented Reality App for Advanced Cardiac Life Support Training: Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Dec", day="5", volume="26", pages="e57327", keywords="augmented reality", keywords="technology intervention", keywords="randomized controlled trial", keywords="advanced cardiac life support", keywords="nursing education", abstract="Background: Advanced cardiac life support (ACLS) skills are essential for nurses. During the COVID-19 pandemic, augmented reality (AR) technologies were incorporated into medical education to increase learning motivation and accessibility. Objective: This study aims to determine whether AR for educational applications can significantly improve crash cart learning, learning motivation, cognitive load, and system usability. It focused on a subgroup of nurses with less than 2 years of experience. Methods: This randomized controlled trial study was conducted in a medical center in southern Taiwan. An ACLS cart training course was developed using AR technologies in the first stage. Additionally, the efficacy of the developed ACLS training course was evaluated. The AR group used a crash cart learning system developed with AR technology, while the control group received traditional lecture-based instruction. Both groups were evaluated immediately after the course. Performance was assessed through learning outcomes related to overall ACLS and crash cart use. The Instructional Materials Motivation Survey, System Usability Scale, and Cognitive Load Theory Questionnaire were also used to assess secondary outcomes in the AR group. Subgroup analyses were performed for nurses with less than 2 years of experience. Results: All 102 nurses completed the course, with 43 nurses in the AR group and 59 nurses in the control group. The AR group outperformed the control group regarding overall ACLS outcomes and crash cart learning outcomes (P=.002; P=.01). The improvement rate was the largest for new staff regardless of the overall learning effect and the crash cart effect. Subgroup analysis revealed that nurses with less than 2 years of experience in the AR group showed more significant improvements in both overall learning (P<.001) and crash cart outcomes (P<.001) compared to their counterparts in the control group. For nurses with more than 2 years of experience, no significant differences were found between the AR and control groups in posttraining learning outcomes for the crash cart (P=.32). The AR group demonstrated high scores for motivation (Instructional Materials Motivation Survey mean score 141.65, SD 19.25) and system usability (System Usability Scale mean score 90.47, SD 11.91), as well as a low score for cognitive load (Cognitive Load Theory Questionnaire mean score 15.42, SD 5.76). Conclusions: AR-based learning significantly improves ACLS knowledge and skills, especially for nurses with less experience, compared to traditional methods. The high usability and motivational benefits of AR suggest its potential for broader applications in nursing education. Trial Registration: ClinicalTrials.gov NCT06057285; https://clinicaltrials.gov/ct2/show/NCT06057285 ", doi="10.2196/57327", url="https://www.jmir.org/2024/1/e57327" } @Article{info:doi/10.2196/56553, author="Marras, Carlos and Labarga, Mar{\'i}a and Ginard, Daniel and Carrascosa, Manuel Jose and Escudero-Contreras, Alejandro and Collantes-Estevez, Eduardo and de Mora, Fernando and Robles, Tamara and Romero, Elisa and Mart{\'i}nez, Rafael", title="An Educational Digital Tool to Improve the Implementation of Switching to a Biosimilar (Rapid Switch Trainer): Tool Development and Validation Study", journal="JMIR Form Res", year="2024", month="Nov", day="21", volume="8", pages="e56553", keywords="consumer health information", keywords="treatment switching", keywords="biosimilar pharmaceuticals", keywords="immune-mediated diseases", keywords="education", keywords="qualitative research", keywords="training", keywords="nocebo", keywords="digital tool", keywords="implementation", abstract="Background: Switching to biosimilars is an effective and safe practice in treating inflammatory diseases; however, a nocebo effect may arise as a result of the way in which the switch is communicated to a given patient. Objective: We aimed to design a gaming-based digital educational tool (including a discussion algorithm) to support the training of health care professionals in efficiently communicating the switch to biosimilars, minimizing the generation of a nocebo effect and thus serving as an implementation strategy for the recommended switch. Methods: The tool was developed based on interviews and focus group discussions with key stakeholders, both patients and health care professionals. Messages likely to either generate trust or to trigger a nocebo effect were generated on the basis of the interviews and focus group discussions. Results: A total 7 clinicians and 4 nurses specializing in rheumatology, gastroenterology, and dermatology, with balanced levels of responsibility and experience, as well as balance between geographic regions, participated in the structured direct interviews and provided a list of arguments they commonly used, or saw used, to justify the switching, and objections given by the patients they attended. Patients with immune-mediated inflammatory diseases who were taking biologic drugs with (n=4) and without (n=5) experience in switching attended the focus groups and interviews. Major topics of discussion were the reason for the change, the nature of biosimilars, and their quality, safety, efficacy, and cost. Based on these discussions, a list of objections and of potential arguments was produced. Patients and health care professionals rated the arguments for their potential to evoke trust or a nocebo effect. Two sets of arguments, related to savings and sustainability, showed discrepant ratings between patients and health care professionals. Objections and arguments were organized by categories and incorporated into the tool as algorithms. The educators then developed additional arguments (with inadequate answers) to complement the valid ones worked on in the focus groups. The tool was then developed as a collection of clinical situations or vignettes that appear randomly to the user, who then has to choose an argument to counteract the given objections. After each interaction, the tool provides feedback. The tool was further supported by accredited medical training on biosimilars and switching. Conclusions: We have developed a digital training tool to improve communication on switching to biosimilars in the clinic and prevent a nocebo effect based on broad and in-depth experiences of patients and health care professionals. The validation of this implementation strategy is ongoing. ", doi="10.2196/56553", url="https://formative.jmir.org/2024/1/e56553" } @Article{info:doi/10.2196/55819, author="Kachimanga, Chiyembekezo and Zaniku, Robbins Haules and Divala, Henry Titus and Ket, C.F Johannes and Mukherjee, S. Joia and Palazuelos, Daniel and Kulinkina, V. Alexandra and Abejirinde, Omolade Ibukun-Oluwa and Akker, den Thomas van", title="Evaluating the Adoption of mHealth Technologies by Community Health Workers to Improve the Use of Maternal Health Services in Sub-Saharan Africa: Systematic Review", journal="JMIR Mhealth Uhealth", year="2024", month="Sep", day="24", volume="12", pages="e55819", keywords="maternal health", keywords="antenatal care", keywords="postnatal care", keywords="facility-based births", keywords="sub-Saharan Africa", keywords="mobile health", keywords="mHealth", keywords="review", keywords="narrative synthesis", keywords="mobile phone", abstract="Background: Limited information exists on the impact of mobile health (mHealth) use by community health workers (CHWs) on improving the use of maternal health services in sub-Saharan Africa (SSA). Objective: This systematic review addresses 2 objectives: evaluating the impact of mHealth use by CHWs on antenatal care (ANC) use, facility-based births, and postnatal care (PNC) use in SSA; and identifying facilitators and barriers to mHealth use by CHWs in programs designed to increase ANC use, facility-based births, and PNC use in SSA using a sociotechnical system approach. Methods: We searched for articles in 6 databases (MEDLINE, CINAHL, Web of Science, Embase, Scopus, and Africa Index Medicus) from inception up to September 2022, with additional articles identified from Google Scholar. After article selection, 2 independent reviewers performed title and abstract screening, full-text screening, and data extraction using Covidence software (Veritas Health Innovation Ltd). In addition, we manually screened the references lists of the included articles. Finally, we performed a narrative synthesis of the outcomes. Results: Among the 2594 records retrieved, 10 (0.39\%) studies (n=22, 0.85\% articles) met the inclusion criteria and underwent data extraction. The studies were published between 2012 and 2022 in 6 countries. Of the studies reporting on ANC outcomes, 43\% (3/7) reported that mHealth use by CHWs increased ANC use. Similarly, of the studies reporting on facility-based births, 89\% (8/9) demonstrated an increase due to mHealth use by CHWs. In addition, in the PNC studies, 75\% (3/4) showed increased PNC use associated with mHealth use by CHWs. Many of the studies reported on the importance of addressing factors related to the social environment of mHealth-enabled CHWs, including the perception of CHWs by the community, trust, relationships, digital literacy, training, mentorship and supervision, skills, CHW program ownership, and the provision of incentives. Very few studies reported on how program goals and culture influenced mHealth use by CHWs. Providing free equipment, accessories, and internet connectivity while addressing ongoing challenges with connectivity, power, the ease of using mHealth software, and equipment maintenance support allowed mHealth-enabled CHW programs to thrive. Conclusions: mHealth use by CHWs was associated with an increase in ANC use, facility-based births, and PNC use in SSA. Identifying and addressing social and technical barriers to the use of mHealth is essential to ensure the success of mHealth programs. Trial Registration: PROSPERO CRD42022346364; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=346364 ", doi="10.2196/55819", url="https://mhealth.jmir.org/2024/1/e55819", url="http://www.ncbi.nlm.nih.gov/pubmed/39316427" } @Article{info:doi/10.2196/59454, author="Sahan, Fatma and Guthardt, Lisa and Panitz, Karin and Siegel-Kianer, Anna and Eichhof, Isabel and Schmitt, D. Bj{\"o}rn and Apolinario-Hagen, Jennifer", title="Enhancing Digital Health Awareness and mHealth Competencies in Medical Education: Proof-of-Concept Study and Summative Process Evaluation of a Quality Improvement Project", journal="JMIR Med Educ", year="2024", month="Sep", day="20", volume="10", pages="e59454", keywords="medical students", keywords="digital health", keywords="design thinking", keywords="digital health literacy", keywords="medical education", keywords="digital health competencies", keywords="mobile phone", abstract="Background: Currently, there is a need to optimize knowledge on digital transformation in mental health care, including digital therapeutics (eg, prescription apps), in medical education. However, in Germany, digital health has not yet been systematically integrated into medical curricula and is taught in a relatively small number of electives. Challenges for lecturers include the dynamic field as well as lacking guidance on how to efficiently apply innovative teaching formats for these new digital competencies. Quality improvement projects provide options to pilot-test novel educational offerings, as little is known about the acceptability of participatory approaches in conventional medical education. Objective: This quality improvement project addressed the gap in medical school electives on digital health literacy by introducing and evaluating an elective scoping study on the systematic development of different health app concepts designed by students to cultivate essential skills for future health care professionals (ie, mobile health [mHealth] competencies). Methods: This proof-of-concept study describes the development, optimization, implementation, and evaluation of a web-based elective on digital (mental) health competencies in medical education. Implemented as part of a quality improvement project, the elective aimed to guide medical students in developing app concepts applying a design thinking approach at a German medical school from January 2021 to January 2024. Topics included defining digital (mental) health, quality criteria for health apps, user perspective, persuasive design, and critical reflection on digitization in medical practice. The elective was offered 6 times within 36 months, with continuous evaluation and iterative optimization using both process and outcome measures, such as web-based questionnaires. We present examples of app concepts designed by students and summarize the quantitative and qualitative evaluation results. Results: In total, 60 students completed the elective and developed 25 health app concepts, most commonly targeting stress management and depression. In addition, disease management and prevention apps were designed for various somatic conditions such as diabetes and chronic pain. The results indicated high overall satisfaction across the 6 courses according to the evaluation questionnaire, with lower scores indicating higher satisfaction on a scale ranging from 1 to 6 (mean 1.70, SD 0.68). Students particularly valued the content, flexibility, support, and structure. While improvements in group work, submissions, and information transfer were suggested, the results underscore the usefulness of the web-based elective. Conclusions: This quality improvement project provides insights into relevant features for the successful user-centered and creative integration of mHealth competencies into medical education. Key factors for the satisfaction of students involved the participatory mindset, focus on competencies, discussions with app providers, and flexibility. Future efforts should define important learning objectives for digital health literacy and provide recommendations for integration rather than debating the need for digital health integration. ", doi="10.2196/59454", url="https://mededu.jmir.org/2024/1/e59454" } @Article{info:doi/10.2196/48810, author="Johnsen, Mari Hege and Nes, Gon{\c{c}}alves Andr{\'e}a Aparecida and Haddeland, Kristine", title="Experiences of Using a Digital Guidance and Assessment Tool (the Technology-Optimized Practice Process in Nursing Application) During Clinical Practice in a Nursing Home: Focus Group Study Among Nursing Students", journal="JMIR Nursing", year="2024", month="Sep", day="10", volume="7", pages="e48810", keywords="application", keywords="assessment of clinical education", keywords="AssCE", keywords="clinical education assessment tool", keywords="electronic reports", keywords="feedback", keywords="guidance model", keywords="smartphone", keywords="Technology-Optimized Practice Process in Nursing", keywords="TOPP-N", keywords="information system success model", keywords="nurse", keywords="nursing", keywords="allied health", keywords="education", keywords="focus group", keywords="focus groups", keywords="technology enhanced learning", keywords="digital health", keywords="content analysis", keywords="student", keywords="students", keywords="nursing home", keywords="long-term care", keywords="learning management", keywords="mobile phone", abstract="Background: Nursing students' learning during clinical practice is largely influenced by the quality of the guidance they receive from their nurse preceptors. Students that have attended placement in nursing home settings have called for more time with nurse preceptors and an opportunity for more help from the nurses for reflection and developing critical thinking skills. To strengthen students' guidance and assessment and enhance students' learning in the practice setting, it has also been recommended to improve the collaboration between faculties and nurse preceptors. Objective: This study explores first-year nursing students' experiences of using the Technology-Optimized Practice Process in Nursing (TOPP-N) application in 4 nursing homes in Norway. TOPP-N was developed to support guidance and assessment in clinical practice in nursing education. Methods: Four focus groups were conducted with 19 nursing students from 2 university campuses in Norway. The data collection and directed content analysis were based on DeLone and McLean's information system success model. Results: Some participants had difficulties learning to use the TOPP-N tool, particularly those who had not attended the 1-hour digital course. Furthermore, participants remarked that the content of the TOPP-N guidance module could be better adjusted to the current clinical placement, level of education, and individual achievements to be more usable. Despite this, most participants liked the TOPP-N application's concept. Using the TOPP-N mobile app for guidance and assessment was found to be very flexible. The frequency and ways of using the application varied among the participants. Most participants perceived that the use of TOPP-N facilitated awareness of learning objectives and enabled continuous reflection and feedback from nurse preceptors. However, the findings indicate that the TOPP-N application's perceived usefulness was highly dependent on the preparedness and use of the app among nurse preceptors (or absence thereof). Conclusions: This study offers information about critical success factors perceived by nursing students related to the use of the TOPP-N application. To develop similar learning management systems that are usable and efficient, developers should focus on personalizing the content, clarifying procedures for use, and enhancing the training and motivation of users, that is, students, nurse preceptors, and educators. ", doi="10.2196/48810", url="https://nursing.jmir.org/2024/1/e48810", url="http://www.ncbi.nlm.nih.gov/pubmed/39255477" } @Article{info:doi/10.2196/50545, author="Thomae, V. Anita and Witt, M. Claudia and Barth, J{\"u}rgen", title="Integration of ChatGPT Into a Course for Medical Students: Explorative Study on Teaching Scenarios, Students' Perception, and Applications", journal="JMIR Med Educ", year="2024", month="Aug", day="22", volume="10", pages="e50545", keywords="medical education", keywords="ChatGPT", keywords="artificial intelligence", keywords="information for patients", keywords="critical appraisal", keywords="evaluation", keywords="blended learning", keywords="AI", keywords="digital skills", keywords="teaching", abstract="Background: Text-generating artificial intelligence (AI) such as ChatGPT offers many opportunities and challenges in medical education. Acquiring practical skills necessary for using AI in a clinical context is crucial, especially for medical education. Objective: This explorative study aimed to investigate the feasibility of integrating ChatGPT into teaching units and to evaluate the course and the importance of AI-related competencies for medical students. Since a possible application of ChatGPT in the medical field could be the generation of information for patients, we further investigated how such information is perceived by students in terms of persuasiveness and quality. Methods: ChatGPT was integrated into 3 different teaching units of a blended learning course for medical students. Using a mixed methods approach, quantitative and qualitative data were collected. As baseline data, we assessed students' characteristics, including their openness to digital innovation. The students evaluated the integration of ChatGPT into the course and shared their thoughts regarding the future of text-generating AI in medical education. The course was evaluated based on the Kirkpatrick Model, with satisfaction, learning progress, and applicable knowledge considered as key assessment levels. In ChatGPT-integrating teaching units, students evaluated videos featuring information for patients regarding their persuasiveness on treatment expectations in a self-experience experiment and critically reviewed information for patients written using ChatGPT 3.5 based on different prompts. Results: A total of 52 medical students participated in the study. The comprehensive evaluation of the course revealed elevated levels of satisfaction, learning progress, and applicability specifically in relation to the ChatGPT-integrating teaching units. Furthermore, all evaluation levels demonstrated an association with each other. Higher openness to digital innovation was associated with higher satisfaction and, to a lesser extent, with higher applicability. AI-related competencies in other courses of the medical curriculum were perceived as highly important by medical students. Qualitative analysis highlighted potential use cases of ChatGPT in teaching and learning. In ChatGPT-integrating teaching units, students rated information for patients generated using a basic ChatGPT prompt as ``moderate'' in terms of comprehensibility, patient safety, and the correct application of communication rules taught during the course. The students' ratings were considerably improved using an extended prompt. The same text, however, showed the smallest increase in treatment expectations when compared with information provided by humans (patient, clinician, and expert) via videos. Conclusions: This study offers valuable insights into integrating the development of AI competencies into a blended learning course. Integration of ChatGPT enhanced learning experiences for medical students. ", doi="10.2196/50545", url="https://mededu.jmir.org/2024/1/e50545" } @Article{info:doi/10.2196/50128, author="Sekiguchi, Kenji and Kawano, Seiji and Chihara, Norio and Satomi-Kobayashi, Seimi and Maeda, Eiichi and Matsumoto, Riki", title="Live Streaming of the Professor's Ward Rounds in Undergraduate Neurology Education: Usability Study", journal="JMIR Form Res", year="2024", month="Aug", day="22", volume="8", pages="e50128", keywords="live streaming", keywords="ward round", keywords="web conferencing software", keywords="neurological examination", keywords="undergraduate education", keywords="medical student", keywords="medical education", keywords="rounds", keywords="remote education", keywords="video-conferencing", keywords="residents", keywords="live-stream", keywords="neurology", keywords="neuroscience", keywords="web conferencing", keywords="distance education", keywords="technology enhanced learning", keywords="mobile phone", abstract="Background: Although neurology department ward rounds are among the most important medical education exercises in Japan, they have several issues. Patients may find it unpleasant to undergo repeated neurological tests, especially when in the presence of several students. Only the front row of students can closely observe the examination findings; moreover, students were prohibited from contacting patients altogether during the COVID-19 pandemic. One possible solution is to use commercial videoconferencing systems. However, Japanese patients are reluctant to have their medical information or video footage of them sent outside of the hospital via the internet. Objective: The study aimed to confirm the feasibility of conducting remote teaching rounds using an in-house web conferencing system in which the patients' personal data are securely protected. This study also explored whether using remote rounds alongside face-to-face participation would enhance learning. Methods: We created an on-premises videoconferencing system using an open-source app. To perform video ward rounds, the professor wore a wireless microphone while leading routine in-person rounds and the attending physician carried a tablet device linked to a web conference, allowing students in another room to watch the rounds on a live stream. In total, 112 of 5th-year students who entered their 1-week neurology rotation between 2021 and 2022 were instructed to participate in 1-hour in-person and remote rounds. Students were given questionnaires to evaluate their satisfaction and the educational effects of the remote rounds. Results: The remote ward rounds were conducted easily with no interference with the in-person rounds, nor any complaints from the patients. Each examination technique was explained by another teacher to the students who participated in remote rounds in the conference room. Characteristic neurological findings, such as plantar reflexes (Babinski sign), which are usually seen only by close observers during in-person rounds, could be visualized under magnification by all students. The postexperience survey (82/112, 73\% response rate) showed that the mean score of participants' satisfaction was 3.94 (SD 0.83; excellent 5 and poor 1). No participant scoring 1 was noted. The proportion of students who observed 6 representative abnormal neurological findings (Babinski sign, hyperreflexia, cerebellar ataxia, involuntary movement, muscular weakness, and abnormality in sensory examination) increased by 22\% (18/82, range 13-24) compared to in-person rounds alone. When self-rating the learning value, 43\% (35/82) of the students answered that remote rounds are equally as valuable as in-person rounds, while 32\% (26/82) preferred remote rounds. Conclusions: Live-streaming of neurology ward rounds using a secure in-house web conferencing system provides additional learning experience without concerns regarding leakage of patient information. This initiative could enhance neurology learning before entering a clinical clerkship. ", doi="10.2196/50128", url="https://formative.jmir.org/2024/1/e50128", url="http://www.ncbi.nlm.nih.gov/pubmed/39172503" } @Article{info:doi/10.2196/53777, author="Nowell, Lorelli and Dolan, Sara and Johnston, Sonja and Jacobsen, Michele and Lorenzetti, Diane and Oddone Paolucci, Elizabeth", title="Exploring Student Perspectives and Experiences of Online Opportunities for Virtual Care Skills Development: Sequential Explanatory Mixed Methods Study", journal="JMIR Nursing", year="2024", month="Aug", day="21", volume="7", pages="e53777", keywords="virtual care", keywords="online teaching and learning", keywords="mixed methods research", keywords="development", keywords="mixed method study", keywords="online", keywords="care", keywords="student", keywords="students", keywords="online learning", keywords="virtual learning", keywords="interview", keywords="experience", keywords="educational", keywords="technology", keywords="nursing", keywords="medicine", keywords="allied health", keywords="teaching", abstract="Background: Caring profession students require skills and competencies to proficiently use information technologies for providing high-quality and effective care. However, there is a gap in exploring the perceptions and experiences of students in developing virtual care skills within online environments. Objective: This study aims to better understand caring professional students' online learning experiences with developing virtual care skills and competencies. Methods: A sequential explanatory mixed methods approach, integrating both a cross-sectional survey and individual interviews, was used to better understand caring professional students' online learning experiences with developing virtual care skills and competencies. Results: A total of 93 survey and 9 interview participants were drawn from various faculties, including students from education, nursing, medicine, and allied health. These participants identified the barriers, facilitators, principles, and skills related to learning about and delivering virtual care, including teaching methods and educational technologies. Conclusions: This study contributes to the growing body of educational research on virtual care skills by offering student insights and suggestions for improved teaching and learning strategies in caring professions' programs. ", doi="10.2196/53777", url="https://nursing.jmir.org/2024/1/e53777", url="http://www.ncbi.nlm.nih.gov/pubmed/39167789" } @Article{info:doi/10.2196/56436, author="Contreras-Ramos, Mery Luz and Laguado Jaimes, Elveny and Jaimes Carvajal, Esperanza Nelly and Pico Ferreira, Marleny and Villamizar-Osorio, Liliana Magda", title="Socioemotional Skills in the Teaching-Learning Process Mediated by Medium- and High-Fidelity Clinical Simulation in Nursing Students: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2024", month="Aug", day="19", volume="13", pages="e56436", keywords="social skills", keywords="nursing students", keywords="high-fidelity simulation training", abstract="Background: In nursing education, contact with real scenarios implies the design of favorable experiences to develop prioritization, reasoning, critical thinking, and management skills that support future practice. In the context of the teaching-learning process, simulation emerges as a support strategy, but its use and management require the knowledge and appropriation of teachers. Clinical simulation during education promotes growth in technical skills and aptitudes such as critical thinking, emotional management, organization, delegation, and teamwork. The culmination positively impacts the student, reflecting on their confidence, security, and adaptability to unexpected or unknown situations and risks. Objective: The aim of this scoping review is to determine the socioemotional skills described during the teaching-learning process mediated by medium- and high-fidelity clinical simulation in nursing students. Methods: The main concepts and limits of the research area will be determined according to the 5 phases of a scoping review proposed by Arksey and O'Malley. Research articles and postgraduate theses published between 2010 and 2023 in English and Spanish will be considered. Dissertation-type documents, book chapters, editorials, abstracts, and articles focused on clinical simulation among nursing professionals will be excluded. The articles will be retrieved from databases available at the Universidad Cooperativa de Colombia, along with CINAHL, Scielo, and PubMed. The search strategy will be based on the Population-Concept-Context framework. Article selection will be carried out by 2 independent evaluators who will review titles and abstracts in stage 1 and the full text in stage 2. A database of retrieved articles will be built with the variables of interest. A qualitative thematic analysis will be conducted by 5 independent reviewers to provide an overview of the literature, focusing on identifying similarities and contrasts between studies and contributions related to the aspects of social skills described in nursing students. Results: The investigation has not yet started. The findings aim to focus on variables within the academic environment that, when correlated with the clinical simulation experience, may determine student learning. The working hypothesis is that students who experience greater satisfaction or possess better communication skills also demonstrate superior performance during high-fidelity simulation activities. The most relevant results will be contrasted considering the stated objective and knowledge gaps. Key aspects will also be compared with other reviews addressing related topics such as communication, self-efficacy, and self-confidence. Skills described by other authors that were not considered in the initial literature review will also be mentioned. Conclusions: Educational institutions are responsible for including learning experiences in controlled environments such as medium- and high-fidelity simulation to ensure the acquisition of technical capabilities and additional socioemotional skills. Recognizing and managing emotions is necessary to provide adequate care for users of health care services and for the increased effectiveness of professionals. Trial Registration: Open Science Framework p4ays; https://osf.io/p4ays International Registered Report Identifier (IRRID): PRR1-10.2196/56436 ", doi="10.2196/56436", url="https://www.researchprotocols.org/2024/1/e56436", url="http://www.ncbi.nlm.nih.gov/pubmed/39158944" } @Article{info:doi/10.2196/48594, author="Tong, Wenting and Zhang, Xiaowen and Zeng, Haiping and Pan, Jianping and Gong, Chao and Zhang, Hui", title="Reforming China's Secondary Vocational Medical Education: Adapting to the Challenges and Opportunities of the AI Era", journal="JMIR Med Educ", year="2024", month="Aug", day="15", volume="10", pages="e48594", keywords="secondary vocational medical education", keywords="artificial intelligence", keywords="practical skills", keywords="critical thinking", keywords="AI", doi="10.2196/48594", url="https://mededu.jmir.org/2024/1/e48594" } @Article{info:doi/10.2196/56722, author="Kapp, M. Julie and Dicke, Rachel and Quinn, Kathleen", title="Online Delivery of Interprofessional Adverse Childhood Experiences Training to Rural Providers: Usability Study", journal="JMIR Pediatr Parent", year="2024", month="Aug", day="7", volume="7", pages="e56722", keywords="adverse childhood experiences", keywords="ACE", keywords="training", keywords="trauma-informed care", keywords="provider", keywords="rural", keywords="adverse", keywords="trauma", keywords="traumatic", keywords="providers", keywords="teaching", keywords="curriculum", keywords="curricula", keywords="education", keywords="educational", keywords="social work", keywords="social worker", keywords="social workers", keywords="psychologist", keywords="psychologists", keywords="counselor", keywords="counselors", keywords="interprofessional", keywords="pediatric", keywords="pediatrics", keywords="paediatric", keywords="paediatrics", keywords="child", keywords="children", keywords="experience", keywords="experiences", keywords="continuing education", abstract="Background: The population health burden of adverse childhood experiences (ACEs) reflects a critical need for evidence-based provider training. Rural children are also more likely than urban children to have any ACEs. A large proportion of providers are unaware of the detrimental effects of ACEs. There is a significant documented need for training providers about ACEs and trauma-informed care, in addition to a demand for that training. Objective: The objective was to develop, implement, and evaluate an online ACEs training curriculum tailored to Missouri providers, particularly those in rural areas given the higher prevalence of ACEs. Methods: From July 2021 to June 2022, we conducted literature reviews and environmental scans of training videos, partner organizations, clinical practice guidelines, and community-based resources to curate appropriate and tailored content for the course. We developed the ACEs training course in the Canvas learning platform (Instructure) with the assistance of an instructional designer and media designer. The course was certified for continuing medical education, as well as continuing education for licensed professional counselors, psychologists, and social workers. Recruitment occurred via key stakeholder email invitations and snowball recruitment. Results: Overall, 135 providers across Missouri requested enrollment, with 72.6\% (n=98) enrolling and accessing the training. Of the latter, 49\% (n=48) completed course requirements, with 100\% of respondents agreeing that the content was relevant to their work, life, or practice; they intend to apply the content to their work, life, or practice; they feel confident to do so; and they would recommend the course to others. Qualitative responses supported active intent to translate knowledge into practice. Conclusions: This study demonstrated the feasibility, acceptability, and effectiveness of interprofessional workforce ACEs training. Robust interest statewide reflects recognition of the topic's importance and intention to translate knowledge into practice. ", doi="10.2196/56722", url="https://pediatrics.jmir.org/2024/1/e56722" } @Article{info:doi/10.2196/60083, author="Zhui, Li and Fenghe, Li and Xuehu, Wang and Qining, Fu and Wei, Ren", title="Ethical Considerations and Fundamental Principles of Large Language Models in Medical Education: Viewpoint", journal="J Med Internet Res", year="2024", month="Aug", day="1", volume="26", pages="e60083", keywords="medical education", keywords="artificial intelligence", keywords="large language models", keywords="medical ethics", keywords="AI", keywords="LLMs", keywords="ethics", keywords="academic integrity", keywords="privacy and data risks", keywords="data security", keywords="data protection", keywords="intellectual property rights", keywords="educational research", doi="10.2196/60083", url="https://www.jmir.org/2024/1/e60083", url="http://www.ncbi.nlm.nih.gov/pubmed/38971715" } @Article{info:doi/10.2196/54473, author="Mikkonen, Kasperi and Helminen, Eeva-Eerika and Saarni, I. Samuli and Saarni, E. Suoma", title="Learning Outcomes of e-Learning in Psychotherapy Training and Comparison With Conventional Training Methods: Systematic Review", journal="J Med Internet Res", year="2024", month="Jul", day="29", volume="26", pages="e54473", keywords="mental health", keywords="psychotherapy", keywords="digital learning", keywords="Kirkpatrick model", keywords="e-learning", keywords="online health", keywords="psychotherapy training", keywords="learning outcome", keywords="learning outcomes", keywords="systematic review", keywords="training methods", keywords="mental disorders", keywords="mental disorder", keywords="accessibility", keywords="evidence-based", keywords="scalability", keywords="cost-effectiveness", keywords="internet", keywords="education", abstract="Background: Mental disorders pose a major public health problem in most western countries. The demand for services for common mental health disorders has been on the rise despite the widespread accessibility of medication. Especially, the supply and demand for evidence-based psychotherapy do not align. Large-scale increase of modern psychotherapy is difficult with current methods of training which are often expensive, time consuming, and dependent on a small number of top-level professionals as trainers. E-learning has been proposed to enhance psychotherapy training accessibility, quality, and scalability. Objective: This systematic review aims to provide an overview of the current evidence regarding e-learning in psychotherapy training. In particular, the review examines the usability, acceptability, and learning outcomes associated with e-learning. Learning outcomes are assessed in different modalities including trainee experiences, knowledge acquisition, skill acquisition, and application of trained content in daily practice. Furthermore, the equivalence of web-based training and conventional training methods is evaluated. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search from Ovid, MEDLINE, PsycINFO, and Scopus databases between 2008 and June 2022 was conducted. Inclusion criteria required studies to describe e-learning systems for psychotherapy training and assess acceptability, feasibility, or learning outcomes. The risk of bias was evaluated for both randomized and nonrandomized studies. Learning outcomes were categorized using the Kirkpatrick model. Effect sizes comparing e-learning and traditional methods were calculated. Results: The search yielded 3380 publications, of which 34 fulfilled the inclusion criteria. Positive learning outcomes are generally associated with various e-learning programs in psychotherapy training including trainee satisfaction, knowledge, and skill acquisition, and in application of trained content in clinical practice. Learning outcomes generally show equivalence between e-learning and conventional training methods. The overall effect size, indicating this disparity, was 0.01, suggesting no significant difference. This literature displays a high level of heterogeneity in e-learning solutions and assessment methods. Conclusions: e-Learning seems to have good potential to enhance psychotherapy training by increasing access, scalability, and cost-effectiveness while maintaining quality in terms of learning outcomes. Results are congruent with findings related to e-learning in health education in general where e-learning as a pedagogy is linked to an opportunity to carry out learner-centric practices. Recommendations for conducting psychotherapy training programs in blended settings supported by activating learning methods are presented. However, due to the heterogeneity and limitations in the existing literature, further research is necessary to replicate these findings and to establish global standards for e-learning, as well as for the assessment of training outcomes in psychotherapy education. Research is especially needed on the effects of training on patient outcomes and optimal ways to combine e-learning and conventional training methods in blended learning settings. ", doi="10.2196/54473", url="https://www.jmir.org/2024/1/e54473", url="http://www.ncbi.nlm.nih.gov/pubmed/39073862" } @Article{info:doi/10.2196/56879, author="Gil-Hern{\'a}ndez, Eva and Carrillo, Irene and Guilabert, Mercedes and Bohomol, Elena and Serpa, C. Piedad and Ribeiro Neves, Vanessa and Maluenda Mart{\'i}nez, Maria and Martin-Delgado, Jimmy and P{\'e}rez-Esteve, Clara and Fern{\'a}ndez, C{\'e}sar and Mira, Joaqu{\'i}n Jos{\'e}", title="Development and Implementation of a Safety Incident Report System for Health Care Discipline Students During Clinical Internships: Observational Study", journal="JMIR Med Educ", year="2024", month="Jul", day="18", volume="10", pages="e56879", keywords="reporting systems", keywords="education", keywords="medical", keywords="nursing", keywords="undergraduate", keywords="patient safety", abstract="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 ", doi="10.2196/56879", url="https://mededu.jmir.org/2024/1/e56879", url="http://www.ncbi.nlm.nih.gov/pubmed/39024005" } @Article{info:doi/10.2196/47438, author="Aqib, Ayma and Fareez, Faiha and Assadpour, Elnaz and Babar, Tubba and Kokavec, Andrew and Wang, Edward and Lo, Thomas and Lam, Jean-Paul and Smith, Christopher", title="Development of a Novel Web-Based Tool to Enhance Clinical Skills in Medical Education", journal="JMIR Med Educ", year="2024", month="Jun", day="20", volume="10", pages="e47438", keywords="medical education", keywords="objective structured clinical examination", keywords="OSCE", keywords="e-OSCE", keywords="Medical Council of Canada", keywords="MCC", keywords="virtual health", keywords="exam", keywords="examination", keywords="utility", keywords="usability", keywords="online learning", keywords="e-learning", keywords="medical student", keywords="medical students", keywords="clinical practice", keywords="clinical skills", keywords="clinical skill", keywords="OSCE tool", doi="10.2196/47438", url="https://mededu.jmir.org/2024/1/e47438" } @Article{info:doi/10.2196/52461, author="He, Yuanhang and Xie, Zhihong and Li, Jiachen and Meng, Ziang and Xue, Dongbo and Hao, Chenjun", title="Global Trends in mHealth and Medical Education Research: Bibliometrics and Knowledge Graph Analysis", journal="JMIR Med Educ", year="2024", month="Jun", day="4", volume="10", pages="e52461", keywords="mHealth", keywords="mobile health", keywords="medical education", keywords="bibliometric", keywords="knowledge map", keywords="VOSviewer", abstract="Background: Mobile health (mHealth) is an emerging mobile communication and networking technology for health care systems. The integration of mHealth in medical education is growing extremely rapidly, bringing new changes to the field. However, no study has analyzed the publication and research trends occurring in both mHealth and medical education. Objective: The aim of this study was to summarize the current application and development trends of mHealth in medical education by searching and analyzing published articles related to both mHealth and medical education. Methods: The literature related to mHealth and medical education published from 2003 to 2023 was searched in the Web of Science core database, and 790 articles were screened according to the search strategy. The HistCite Pro 2.0 tool was used to analyze bibliometric indicators. VOSviewer, Pajek64, and SCImago Graphica software were used to visualize research trends and identify hot spots in the field. Results: In the past two decades, the number of published papers on mHealth in medical education has gradually increased, from only 3 papers in 2003 to 130 in 2022; this increase became particularly evident in 2007. The global citation score was determined to be 10,600, with an average of 13.42 citations per article. The local citation score was 96. The United States is the country with the most widespread application of mHealth in medical education, and most of the institutions conducting in-depth research in this field are also located in the United States, closely followed by China and the United Kingdom. Based on current trends, global coauthorship and research exchange will likely continue to expand. Among the research journals publishing in this joint field, journals published by JMIR Publications have an absolute advantage. A total of 105 keywords were identified, which were divided into five categories pointing to different research directions. Conclusions: Under the influence of COVID-19, along with the popularization of smartphones and modern communication technology, the field of combining mHealth and medical education has become a more popular research direction. The concept and application of digital health will be promoted in future developments of medical education. ", doi="10.2196/52461", url="https://mededu.jmir.org/2024/1/e52461" } @Article{info:doi/10.2196/54188, author="Yoo, Suyoung and Heo, Sejin and Song, Soojin and Park, Aeyoung and Cho, Hyunchung and Kim, Yuna and Cha, Chul Won and Kim, Kyeongsug and Son, Hi Meong", title="Adoption of Augmented Reality in Educational Programs for Nurses in Intensive Care Units of Tertiary Academic Hospitals: Mixed Methods Study", journal="JMIR Serious Games", year="2024", month="May", day="23", volume="12", pages="e54188", keywords="augmented reality", keywords="AR", keywords="clinical skills education", keywords="nurse education", keywords="technology-based education", keywords="education", keywords="nurse", keywords="nursing", keywords="allied health", keywords="technology-enhanced learning", keywords="interview", keywords="training", keywords="usability", keywords="acceptability", keywords="educational", keywords="teaching", keywords="ICU", keywords="intensive care unit", keywords="self-guided", keywords="self-directed", keywords="hands-on", keywords="adoption", keywords="TAM", keywords="Technology Acceptance Model", keywords="skill", keywords="acquisition", abstract="Background: In the wake of challenges brought by the COVID-19 pandemic to conventional medical education, the demand for innovative teaching methods has surged. Nurse training, with its focus on hands-on practice and self-directed learning, encountered significant hurdles with conventional approaches. Augmented reality (AR) offers a potential solution to addressing this issue. Objective: The aim of this study was to develop, introduce, and evaluate an AR-based educational program designed for nurses, focusing on its potential to facilitate hands-on practice and self-directed learning. Methods: An AR-based educational program for nursing was developed anchored by the Kern six-step framework. First, we identified challenges in conventional teaching methods through interviews and literature reviews. Interviews highlighted the need for hands-on practice and on-site self-directed learning with feedback from a remote site. The training goals of the platform were established by expert trainers and researchers, focusing on the utilization of a ventilator and extracorporeal membrane oxygenation system. Intensive care nurses were enrolled to evaluate AR education. We then assessed usability and acceptability of the AR training using the System Usability Scale and Technology Acceptance Model with intensive care nurses who agreed to test the new platform. Additionally, selected participants provided deeper insights through semistructured interviews. Results: This study highlights feasibility and key considerations for implementing an AR-based educational program for intensive care unit nurses, focusing on training objectives of the platform. Implemented over 2 months using Microsoft Dynamics 365 Guides and HoloLens 2, 28 participants were trained. Feedback gathered through interviews with the trainers and trainees indicated a positive reception. In particular, the trainees mentioned finding AR particularly useful for hands-on learning, appreciating its realism and the ability for repetitive practice. However, some challenges such as difficulty in adapting to the new technology were expressed. Overall, AR exhibits potential as a supplementary tool in nurse education. Conclusions: To our knowledge, this is the first study to substitute conventional methods with AR in this specific area of critical care nursing. These results indicate the multiple principal factors to take into consideration when adopting AR education in hospitals. AR is effective in promoting self-directed learning and hands-on practice, with participants displaying active engagement and enhanced skill acquisition. Trial Registration: ClinicalTrials.gov NCT05629663; https://clinicaltrials.gov/study/NCT05629663. ", doi="10.2196/54188", url="https://games.jmir.org/2024/1/e54188", url="http://www.ncbi.nlm.nih.gov/pubmed/38780998" } @Article{info:doi/10.2196/55238, author="Ssekkadde, Peter and Tomberge, Jelena Vica Marie and Brugger, Curdin and Atuhaire, Aggrey and Dalvie, Aqiel Mohamed and Rother, Hanna-Andrea and R{\"o}{\"o}sli, Martin and Inauen, Jennifer and Fuhrimann, Samuel", title="Evaluating and Enhancing an Educational Intervention to Reduce Smallholder Farmers' Exposure to Pesticides in Uganda Through a Digital, Systematic Approach to Behavior Change: Protocol for a Cluster-Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="May", day="8", volume="13", pages="e55238", keywords="smallholder farmers", keywords="knowledge", keywords="attitude", keywords="practice", keywords="behavior change", keywords="psychosocial determinants of behavior", keywords="health", keywords="education", keywords="pesticide exposure", keywords="SMS text messages", abstract="Background: Smallholder farmers receive educational interventions on safe pesticide handling by governmental agencies, industries, or nongovernmental organizations to reduce exposure risks. However, existing educational interventions have limited effects on changing behaviors. Targeting psychosocial determinants of behavior change in educational interventions through theory- and evidence-based approaches may enhance their effectiveness. Objective: We aim at describing the intervention development and study design of a 3-arm cluster-randomized controlled trial to assess the effects in improving safe pesticide handling and reducing pesticide exposure of (1) an existing educational intervention and (2) a newly developed SMS text messaging intervention based on the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) behavior change approach. Methods: We enrolled 539 Ugandan smallholder farmers in 12 clusters (subcounties). The clusters, each with 45 farmers, were randomly allocated to one of the three arms: (1) educational intervention, (2) educational intervention+RANAS-based SMS text messages, or (3) control group. The educational intervention comprised a 2-day workshop that targeted multiple aspects of safe pesticide handling, whereas the SMS text messages targeted the use of personal protective equipment (PPE) and were based on the RANAS approach. For intervention development in this study, this approach includes identifying psychosocial determinants of PPE use at baseline and selecting behavior change techniques to target them in SMS text messages. The primary outcomes of the study are (1) pesticide knowledge, attitude, and practice scores indicating performance throughout the educational intervention; and (2) frequency of PPE use. Secondary outcomes are the RANAS-based behavioral determinants of PPE use, the frequency of glove use, algorithm-based pesticide exposure intensity scores, and signs and symptoms of pesticide poisoning. The outcomes were assessed in structured interviews before the intervention (baseline) and at the 12-month follow-up. The effect of the interventions among the arms will be analyzed using the intervention arms and baseline measures as predictors and the follow-up measures as outcomes in linear multivariable mixed models including the clusters as random effects. The mediating psychosocial determinants of the interventions will be assessed in multiple mediation models. Results: The study was conducted from 2020 to 2021---baseline interviews were conducted in October 2020, and the educational intervention was delivered in November 2020. The RANAS-based SMS text messages were developed based on the baseline data for relevant behavioral determinants of PPE use and sent between February 2021 and September 2021. Follow-up interviews were conducted in October 2021. Overall, 539 farmers were enrolled in the study at baseline; 8.3\% (45/539) were lost to follow-up by the end of the study. Conclusions: This study will contribute to a better understanding of the effectiveness and behavior change mechanisms of educational interventions by using an experimental, cluster-randomized study design to improve pesticide handling among smallholder farmers. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) 18237656; https://doi.org/10.1186/ISRCTN18237656 International Registered Report Identifier (IRRID): DERR1-10.2196/55238 ", doi="10.2196/55238", url="https://www.researchprotocols.org/2024/1/e55238", url="http://www.ncbi.nlm.nih.gov/pubmed/38718387" } @Article{info:doi/10.2196/51346, author="Skryd, Anthony and Lawrence, Katharine", title="ChatGPT as a Tool for Medical Education and Clinical Decision-Making on the Wards: Case Study", journal="JMIR Form Res", year="2024", month="May", day="8", volume="8", pages="e51346", keywords="ChatGPT", keywords="medical education", keywords="large language models", keywords="LLMs", keywords="clinical decision-making", abstract="Background: Large language models (LLMs) are computational artificial intelligence systems with advanced natural language processing capabilities that have recently been popularized among health care students and educators due to their ability to provide real-time access to a vast amount of medical knowledge. The adoption of LLM technology into medical education and training has varied, and little empirical evidence exists to support its use in clinical teaching environments. Objective: The aim of the study is to identify and qualitatively evaluate potential use cases and limitations of LLM technology for real-time ward-based educational contexts. Methods: A brief, single-site exploratory evaluation of the publicly available ChatGPT-3.5 (OpenAI) was conducted by implementing the tool into the daily attending rounds of a general internal medicine inpatient service at a large urban academic medical center. ChatGPT was integrated into rounds via both structured and organic use, using the web-based ``chatbot'' style interface to interact with the LLM through conversational free-text and discrete queries. A qualitative approach using phenomenological inquiry was used to identify key insights related to the use of ChatGPT through analysis of ChatGPT conversation logs and associated shorthand notes from the clinical sessions. Results: Identified use cases for ChatGPT integration included addressing medical knowledge gaps through discrete medical knowledge inquiries, building differential diagnoses and engaging dual-process thinking, challenging medical axioms, using cognitive aids to support acute care decision-making, and improving complex care management by facilitating conversations with subspecialties. Potential additional uses included engaging in difficult conversations with patients, exploring ethical challenges and general medical ethics teaching, personal continuing medical education resources, developing ward-based teaching tools, supporting and automating clinical documentation, and supporting productivity and task management. LLM biases, misinformation, ethics, and health equity were identified as areas of concern and potential limitations to clinical and training use. A code of conduct on ethical and appropriate use was also developed to guide team usage on the wards. Conclusions: Overall, ChatGPT offers a novel tool to enhance ward-based learning through rapid information querying, second-order content exploration, and engaged team discussion regarding generated responses. More research is needed to fully understand contexts for educational use, particularly regarding the risks and limitations of the tool in clinical settings and its impacts on trainee development. ", doi="10.2196/51346", url="https://formative.jmir.org/2024/1/e51346", url="http://www.ncbi.nlm.nih.gov/pubmed/38717811" } @Article{info:doi/10.2196/53997, author="Grosjean, Julien and Dufour, Frank and Benis, Arriel and Januel, Jean-Marie and Staccini, Pascal and Darmoni, Jacques St{\'e}fan", title="Digital Health Education for the Future: The SaNuRN (Sant{\'e} Num{\'e}rique Rouen-Nice) Consortium's Journey", journal="JMIR Med Educ", year="2024", month="Apr", day="30", volume="10", pages="e53997", keywords="digital health", keywords="medical informatics", keywords="education", keywords="health education", keywords="curriculum", keywords="students", keywords="teaching materials", keywords="hybrid learning", keywords="program development", keywords="capacity building", keywords="access to information", keywords="e-learning", keywords="open access", keywords="open data", keywords="skills framework", keywords="competency-based learning", keywords="telemedicine training", keywords="medical simulation", keywords="objective structured clinical examination", keywords="OSCE", keywords="script concordance test", keywords="SCT", keywords="virtual patient", doi="10.2196/53997", url="https://mededu.jmir.org/2024/1/e53997" } @Article{info:doi/10.2196/52679, author="Thiesmeier, Robert and Orsini, Nicola", title="Rolling the DICE (Design, Interpret, Compute, Estimate): Interactive Learning of Biostatistics With Simulations", journal="JMIR Med Educ", year="2024", month="Apr", day="15", volume="10", pages="e52679", keywords="learning statistics", keywords="Monte Carlo simulation", keywords="simulation-based learning", keywords="survival analysis", keywords="Weibull", doi="10.2196/52679", url="https://mededu.jmir.org/2024/1/e52679", url="http://www.ncbi.nlm.nih.gov/pubmed/38619866" } @Article{info:doi/10.2196/57280, author="Agley, Jon and Henderson, Cris and Seo, Dong-Chul and Parker, Maria and Golzarri-Arroyo, Lilian and Dickinson, Stephanie and Tidd, David", title="The Feasibility of Using the National PulsePoint Cardiopulmonary Resuscitation Responder Network to Facilitate Overdose Education and Naloxone Distribution: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Mar", day="29", volume="13", pages="e57280", keywords="naloxone", keywords="PulsePoint", keywords="randomized controlled trial", keywords="RCT", keywords="first responder", keywords="overdose", keywords="community engagement", keywords="citizen mobilization", keywords="opioids", keywords="Narcan", keywords="mobile phone", abstract="Background: The use of naloxone, an opioid antagonist, is a critical component of the US response to fatal opioid-involved overdoses. The importance and utility of naloxone in preventing fatal overdoses have been widely declaimed by medical associations and government officials and are supported by strong research evidence. Still, there are gaps in the current US national strategy because many opioid-involved overdose fatalities have no evidence of naloxone administration. Improving the likelihood that naloxone will be used to prevent fatal overdoses is predicated on facilitating an environment wherein naloxone is available near each overdose and can be accessed by someone who is willing and able to use it. How to accomplish this on a national scale has been unclear. However, there exists a national network of >1 million cardiopulmonary resuscitation (CPR) layperson responders and 4800 emergency responder agencies linked through a mobile phone app called PulsePoint Respond. PulsePoint responders certify that they are trained to administer CPR and are willing to respond to possible cardiac events in public. When such an event occurs near their mobile phone's location, they receive an alert to respond. These motivated citizens are ideally positioned to carry naloxone and reverse overdoses that occur in public. Objective: This randomized controlled trial will examine the feasibility of recruiting first responder agencies and layperson CPR responders who already use PulsePoint to obtain overdose education and carry naloxone. Methods: This will be a 3-arm parallel-group randomized controlled trial. We will randomly select 180 first responder agencies from the population of agencies contracting with the PulsePoint Foundation. The 3 study arms will include a standard recruitment arm, a misperception-correction recruitment arm, and a control arm (1:1:1 allocation, with random allocation stratified by zip code designation [rural or nonrural]). We will study agency recruitment and, among the agencies we successfully recruit, responder certification of receiving overdose and naloxone education, carrying naloxone, or both. Hypothesis 1 contrasts agency recruitment success between arms 1 and 2, and hypothesis 2 contrasts the ratios of layperson certification across all 3 arms. The primary analyses will be a logistic regression comparing the recruitment rates among the arms, adjusting for rural or nonrural zip code designation. Results: This study was reviewed by the Indiana University Institutional Review Board (20218 and 20219). This project was funded beginning September 14, 2023, by the National Institute on Drug Abuse. Conclusions: The hypotheses in this study will test whether a specific type of messaging is particularly effective in recruiting agencies and layperson responders. Although we hypothesize that arm 2 will outperform the other arms, our intention is to use the best-performing approach in the next phase of this study if any of our approaches demonstrates feasibility. Trial Registration: OSF Registries osf.io/egn3z; https://osf.io/egn3z International Registered Report Identifier (IRRID): PRR1-10.2196/57280 ", doi="10.2196/57280", url="https://www.researchprotocols.org/2024/1/e57280", url="http://www.ncbi.nlm.nih.gov/pubmed/38551636" } @Article{info:doi/10.2196/53284, author="Mart{\'i}nez-Gaitero, Carlos and Dennerlein, Maximilian Sebastian and Dobrowolska, Beata and Fessl, Angela and Moreno-Mart{\'i}nez, Daniel and Herbstreit, Stephanie and Peffer, Gilbert and Cabrera, Esther and ", title="Connecting Actors With the Introduction of Mobile Technology in Health Care Practice Placements (4D Project): Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2024", month="Feb", day="8", volume="13", pages="e53284", keywords="practice-based learning", keywords="practice placement", keywords="technology enhanced learning", keywords="mobile learning", keywords="co-design", keywords="cocreation", keywords="higher education", keywords="health professionals", keywords="health students.", abstract="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 ", doi="10.2196/53284", url="https://www.researchprotocols.org/2024/1/e53284", url="http://www.ncbi.nlm.nih.gov/pubmed/38329786" } @Article{info:doi/10.2196/46336, author="K{\"o}nig, Lars and Suhr, Ralf", title="The Effectiveness of Publicly Available Web-Based Interventions in Promoting Health App Use, Digital Health Literacy, and Media Literacy: Pre-Post Evaluation Study", journal="J Med Internet Res", year="2023", month="Dec", day="4", volume="25", pages="e46336", keywords="digital health literacy", keywords="e-learning", keywords="health apps", keywords="health education", keywords="health literacy", keywords="media literacy", keywords="mHealth", keywords="mobile health", keywords="serious games", keywords="user experience", keywords="web-based intervention", abstract="Background: According to the World Health Organization, implementing mobile health (mHealth) technologies can increase access to quality health services worldwide. mHealth apps for smartphones, also known as health apps, are a central component of mHealth, and they are already used in diverse medical contexts. To benefit from health apps, potential users need specific skills that enable them to use such apps in a responsible and constructive manner. Objective: This study aimed to evaluate the effectiveness of the free and widely used web-based intervention, The APPocalypse?. Besides providing knowledge about health apps, the web-based intervention was designed to promote digital health and media literacy by teaching skills that enable users to distinguish between trustworthy and less trustworthy health apps. It was hypothesized that after completing the web-based intervention, participants' knowledge in the domain of health apps, their digital health literacy, and their media literacy would be higher than it was before completing the web-based intervention. Methods: The study was divided into 3 parts. During part 1, participants (n=365; 181 female, 181 male, and 3 diverse; mean age 17.74, SD 1.391 years) provided demographic information and answered the pre- and postmeasurements. The measurements included questionnaires about participants' knowledge in the domain of health apps, digital health literacy, and media literacy. During part 2, participants had 1 week to complete the web-based intervention. During part 3, participants answered the pre- and postmeasurements again. Furthermore, they answered educational quality and user experience questionnaires. Bayesian paired samples 2-tailed t tests were conducted to test the hypotheses. Results: Overall, the results support the hypotheses. After completing the web-based intervention, participants demonstrated more elaborate knowledge in the domain of health apps. Specifically, they displayed higher competencies in the domains of subjective (Bayes factor10 [BF10]=1.475{\texttimes}1079; effect size $\delta$=--1.327) and objective health app knowledge (BF10=8.162{\texttimes}1080; effect size $\delta$=--1.350). Furthermore, participants demonstrated higher digital health literacy. Specifically, they displayed higher competencies in the domains of information appraisal (BF10=3.413{\texttimes}1043; effect size $\delta$=--0.870), information searching (BF10=3.324{\texttimes}1023; effect size $\delta$=--0.604), evaluating reliability (BF10=3.081{\texttimes}1035; effect size $\delta$=--0.766), and determining relevance (BF10=3.451{\texttimes}1024; effect size $\delta$=--0.618). Regarding media literacy, the results were mixed. Participants displayed higher competencies in the domain of technology literacy beliefs (BF10=1.533{\texttimes}1021; effect size $\delta$=--0.570). In the domain of technology control beliefs, their competencies did not seem to improve (BF10=0.109; effect size $\delta$=--0.058). In comparison to relevant benchmarks, the web-based intervention offers exceptional educational quality and a superior user experience. Conclusions: The free web-based intervention The APPocalypse? might promote the constructive use of health apps, digital health literacy, and media literacy. Therefore, it may contribute to achieving the health-related United Nations Sustainable Development Goals. ", doi="10.2196/46336", url="https://www.jmir.org/2023/1/e46336", url="http://www.ncbi.nlm.nih.gov/pubmed/38048146" } @Article{info:doi/10.2196/47977, author="Li, Casey and Salman, Maria and Esmail, Tariq and Matava, Clyde", title="Use of Peer-Led Web-Based Platforms for Peer-Assisted Learning Among Canadian Anesthesia Residents and Fellows: Cross-Sectional Study", journal="JMIR Form Res", year="2023", month="Nov", day="13", volume="7", pages="e47977", keywords="medical education", keywords="anesthesia", keywords="residents", keywords="fellowship", keywords="social media", keywords="peer led", keywords="peer assisted learning", keywords="anesthesiology", keywords="mobile device usage", keywords="health care", keywords="medical trainee", keywords="perception", keywords="mobile app", keywords="digital health", abstract="Background: Peer-assisted learning (PAL) using peer-led web-based platforms (PWPs), including social media, can be a highly effective method of supporting medical trainees. PWPs, such as mobile apps for sharing anesthesia resources and social media groups or discussion forums pertaining to anesthesia training, may play a role in facilitating anesthesia trainee-led web-based education. However, there have been many challenges facing anesthesia trainees when it comes to incorporating PWPs, especially social media and mobile apps for PAL. Objective: The primary objective of this survey was to assess the proportion of trainees that use social media and mobile apps. The secondary objective was to identify the trainees' perceptions on the use of social media and mobile apps for educational purposes, including PAL. Methods: This cross-sectional study was conducted through a survey administered via email at a single large academic center. The survey tool collected data between 2016 and 2017 on the following: demographic data (year of study, field of specialty), use of technology and web-based resources for medicine, use of social media platforms for anesthesia or training, benefits and barriers to future uses of social media for training, and ideas for trainee-led websites. Descriptive statistics were reported. Results: In total, 80 anesthesia trainees (51 residents and 29 fellows) responded to the survey (response rate of 33\% of out 240 trainees contacted). All trainees reported having a mobile device that most (n=61, 76\%) reported using multiple times a day to access medical resources. The highest perceived benefits of PWPs according to residents were that the most valuable information was available on-demand (n=27, 53\%), they saved time (n=27, 53\%), and they improved their overall learning experience within anesthesia (n=24, 47\%). In comparison, fellows thought that PWPs were beneficial because they provided multiple perspectives of a single topic (n=13, 45\%) and served as an additional platform to discuss ideas with peers (n=13, 45\%). The most popular platforms used by both residents and fellows were Facebook (residents: n=44, 86\%; fellows: n=26, 90\%) followed by LinkedIn (residents: n=21, 42\%; fellows: n=9, 29\%). Even though most anesthesia trainees used social media for personal reasons, only 26\% (n=21) reported having used resident- or fellow-driven PWP resources. Examples of PWPs that trainees used included anesthesia groups and a resident Dropbox resource folder. Conclusions: There was generally an acceptance for using PWPs for PAL as they provided various benefits for trainees at all levels of learning. PWPs have the potential to garner an increased sense of community and sharing within learning experiences throughout all levels of training.?The information gained from this survey will help inform the basis for developing an anesthesia trainee-led e-learning platform. ", doi="10.2196/47977", url="https://formative.jmir.org/2023/1/e47977", url="http://www.ncbi.nlm.nih.gov/pubmed/37955954" } @Article{info:doi/10.2196/47777, author="Gisondi, Albert Michael and Keyes, Timothy and Zucker, Shana and Bumgardner, Deila", title="Teaching LGBTQ+ Health, a Web-Based Faculty Development Course: Program Evaluation Study Using the RE-AIM Framework", journal="JMIR Med Educ", year="2023", month="Jul", day="21", volume="9", pages="e47777", keywords="lesbian, gay, bisexual, transgender, queer", keywords="LGBTQ+", keywords="queer", keywords="faculty development", keywords="medical education", keywords="continuing education", keywords="sexual and gender minority", keywords="web-based learning", keywords="asynchronous learning", keywords="education technology", keywords="diversity, equity, inclusion", keywords="DEI", abstract="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. ", doi="10.2196/47777", url="https://mededu.jmir.org/2023/1/e47777", url="http://www.ncbi.nlm.nih.gov/pubmed/37477962" } @Article{info:doi/10.2196/37140, author="Gardiner, Heather and Siminoff, Laura and Gordon, J. Elisa and Alolod, Gerard and Richardson, Briana and Schupler, Melanie and Benitez, Amanda and Hernandez, Ilda and Guinansaca, Nancy and Ramos, Lori and Bergeron, D. Caroline and Pappaterra, Lianette and Norden, Robert and Daly, Theresa", title="Direct and Indirect Effects of a Web-Based Educational and Communication Skills Intervention ``Promotoras de Donaci{\'o}n'' to Increase Donor Designation in Latinx Communities: Evaluation Study", journal="J Med Internet Res", year="2023", month="Jul", day="10", volume="25", pages="e37140", keywords="Latinx", keywords="Latino", keywords="Latina", keywords="Spanish", keywords="Hispanic organ donation", keywords="organ donor", keywords="donor registration", keywords="donor designation", keywords="education", keywords="e-learning", keywords="digital learning", keywords="promotoras", keywords="program evaluation", keywords="community outreach", keywords="community engagement", keywords="awareness", abstract="Background: Latinx populations are severely underrepresented among organ donors compared with the non-Hispanic White population. The Promotoras de Donaci{\'o}n e-learning module was developed to train Latinx lay health educators (ie, promotoras) to discuss deceased organ donation and promote donor designation within their communities. Objective: This paper described the results of 2 studies designed to assess the direct and indirect effects of the module on promotoras' and mature Latinas' organ donation and donor designation knowledge, attitudes, and behaviors. Methods: In partnership with 4 community-based promotoras organizations, we designed 2 nonrandomized, quasiexperimental pragmatic studies to evaluate the Promotoras de Donaci{\'o}n e-learning module, with participating promotoras and mature Latinas serving as their own controls. Brief surveys were administered to participating promotoras before and after module completion to assess changes in organ donation knowledge and support and communication confidence (study 1). Promotoras participating in the first study were asked to hold at least 2 group conversations about organ donation and donor designation with mature Latinas (study 2); paper-pencil surveys were completed by all participants before and after the group conversations. Descriptive statistics, means and SDs, and counts and percentages were used as appropriate to categorize the samples. Paired sample 2-tailed t test was used to assess changes in knowledge of and support for organ donation and confidence in discussing donation and promoting donor designation from pre- to posttest. Results: Overall, 40 promotoras completed this module (study 1). Increases in organ donation knowledge (mean 6.0, SD 1.9 to mean 6.2, SD 2.9) and support (mean 3.4, SD 0.9 to mean 3.6, SD 0.9) were observed from pre- to posttest; however, these changes did not reach statistical significance. A statistically significant increase in communication confidence was found (mean 692.1, SD 232.4 to mean 852.3, SD 139.7; P=.01). The module was well received, with most participants deeming it well organized, presenting new information, and providing realistic and helpful portrayals of donation conversations. A total of 52 group discussions with 375 attendees were led by 25 promotoras (study 2). The trained promotora-led group discussions about organ donation resulted in increased support for organ donation in promotoras and mature Latinas from pre- to posttest. Knowledge of the steps to become an organ donor and belief that the process is easy to perform increased in mature Latinas from pre- to posttest by 30.7\% and 15.2\%, respectively. In total, 5.6\% (21/375) of attendees submitted completed organ donation registration forms. Conclusions: This evaluation provides preliminary support for the module's direct and indirect effects on organ donation knowledge, attitudes, and behaviors. The need for additional modifications to and future evaluations of the module are discussed. ", doi="10.2196/37140", url="https://www.jmir.org/2023/1/e37140", url="http://www.ncbi.nlm.nih.gov/pubmed/37428526" } @Article{info:doi/10.2196/45464, author="Dinh, Alana and Yin, Lukas Andrew and Estrin, Deborah and Greenwald, Peter and Fortenko, Alexander", title="Augmented Reality in Real-time Telemedicine and Telementoring: Scoping Review", journal="JMIR Mhealth Uhealth", year="2023", month="Apr", day="18", volume="11", pages="e45464", keywords="augmented reality", keywords="telemedicine", keywords="telehealth", keywords="telementoring", keywords="teleguidance", keywords="telecommunication", keywords="teleconsultation", keywords="telecollaboration", keywords="scoping review", keywords="mobile phone", abstract="Background: Over the last decade, augmented reality (AR) has emerged in health care as a tool for visualizing data and enhancing simulation learning. AR, which has largely been explored for communication and collaboration in nonhealth contexts, could play a role in shaping future remote medical services and training. This review summarized existing studies implementing AR in real-time telemedicine and telementoring to create a foundation for health care providers and technology developers to understand future opportunities in remote care and education. Objective: This review described devices and platforms that use AR for real-time telemedicine and telementoring, the tasks for which AR was implemented, and the ways in which these implementations were evaluated to identify gaps in research that provide opportunities for further study. Methods: We searched PubMed, Scopus, Embase, and MEDLINE to identify English-language studies published between January 1, 2012, and October 18, 2022, implementing AR technology in a real-time interaction related to telemedicine or telementoring. The search terms were ``augmented reality'' OR ``AR'' AND ``remote'' OR ``telemedicine'' OR ``telehealth'' OR ``telementoring.'' Systematic reviews, meta-analyses, and discussion-based articles were excluded from analysis. Results: A total of 39 articles met the inclusion criteria and were categorized into themes of patient evaluation, medical intervention, and education. In total, 20 devices and platforms using AR were identified, with common features being the ability for remote users to annotate, display graphics, and display their hands or tools in the local user's view. Common themes across the studies included consultation and procedural education, with surgery, emergency, and hospital medicine being the most represented specialties. Outcomes were most often measured using feedback surveys and interviews. The most common objective measures were time to task completion and performance. Long-term outcome and resource cost measurements were rare. Across the studies, user feedback was consistently positive for perceived efficacy, feasibility, and acceptability. Comparative trials demonstrated that AR-assisted conditions had noninferior reliability and performance and did not consistently extend procedure times compared with in-person controls. Conclusions: Studies implementing AR in telemedicine and telementoring demonstrated the technology's ability to enhance access to information and facilitate guidance in multiple health care settings. However, AR's role as an alternative to current telecommunication platforms or even in-person interactions remains to be validated, with many disciplines and provider-to-nonprovider uses still lacking robust investigation. Additional studies comparing existing methods may offer more insight into this intersection, but the early stage of technical development and the lack of standardized tools and adoption have hindered the conduct of larger longitudinal and randomized controlled trials. Overall, AR has the potential to complement and advance the capabilities of remote medical care and learning, creating unique opportunities for innovator, provider, and patient involvement. ", doi="10.2196/45464", url="https://mhealth.jmir.org/2023/1/e45464", url="http://www.ncbi.nlm.nih.gov/pubmed/37071458" } @Article{info:doi/10.2196/40350, author="Perrin, Julien and Meeus, Am{\'e}lie and Broseus, Julien and Morieux, Pierre-Jean and Di Ceglie, Valentine and Gravoulet, Julien and D'Aveni, Maud", title="A Serious Game About Hematology for Health Care Workers (SUPER HEMO): Development and Validation Study", journal="JMIR Serious Games", year="2023", month="Feb", day="13", volume="11", pages="e40350", keywords="educational technology", keywords="hematology", keywords="health care students", keywords="education", keywords="teaching", keywords="validation", keywords="methodological study", keywords="video support tool", keywords="continuing education", keywords="serious games", keywords="educational games", abstract="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. ", doi="10.2196/40350", url="https://games.jmir.org/2023/1/e40350", url="http://www.ncbi.nlm.nih.gov/pubmed/36780215" } @Article{info:doi/10.2196/43263, author="Ditton, Elizabeth and Knott, Brendon and Hodyl, Nicolette and Horton, Graeme and Walker, Rohan Frederick and Nilsson, Michael", title="Medical Student Experiences of Engaging in a Psychological Flexibility Skill Training App for Burnout and Well-being: Pilot Feasibility Study", journal="JMIR Form Res", year="2023", month="Jan", day="10", volume="7", pages="e43263", keywords="medical students", keywords="burnout prevention", keywords="app", keywords="feasibility", keywords="intervention engagement", keywords="psychological flexibility", keywords="acceptance and commitment therapy", keywords="mobile phone", abstract="Background: Medical students are at higher risk of burnout than the general population. Interventions that facilitate adaptive coping behaviors (eg, Psychological Flexibility) in the context of inherent stressors associated with medical training could mitigate burnout risk and improve well-being. Delivering these interventions using smartphone apps offers advantages such as accessibility, scalability, mitigation of time and stigma barriers, and facilitation of individual tailoring (individualization). There is a need for feasibility trials with medical students in this emerging field. Formal evaluations of user experiences of app-based psychological skill training are required to identify barriers to and facilitators of engagement and optimize intervention development before implementation in efficacy trials and real-world settings. Objective: This study aimed to assess the feasibility of delivering an individualized Psychological Flexibility skill training intervention (Acceptance and Commitment Training [ACTraining]) to medical students using an app-based delivery format. We further aimed to explore how formal evaluation of user experiences might inform and guide the development of this app before implementation in an efficacy trial and future research involving app-delivered psychological skill training for medical students. Methods: This single-arm study was an early-phase feasibility trial of a stand-alone ACTraining app conducted with a sample of Australian medical students (n=11). We collected app usability and user experience data across a broad range of domains (eg, perceived helpfulness and relevance, learning experiences, and self-efficacy) using self-report questionnaires (quantitative and qualitative) and behavioral engagement outcomes. Results: Behavioral engagement data demonstrated that the app delivered the assessment procedures and individualized ACTraining intervention to medical students as intended. The subjective feedback provided by students who actively engaged with the app was generally positive across several indicators, including usability, perceived relevance and helpfulness, accessibility, maintenance of privacy, and opportunity for self-reflection. Disengagement from the app was an identified challenge throughout the trial. Participant feedback identified several factors that may have affected engagement, such as time, expectations regarding app interface functioning, and individual differences in confidence and self-efficacy when implementing skills. Conclusions: This study reports user experience data that have been largely absent from the literature on digital psychological interventions for medical students. Our findings demonstrate the preliminary feasibility of an app-delivered ACTraining intervention for medical student well-being and burnout and support the value of future assessment of the efficacy of this approach with larger samples. We consider subjective feedback from medical students in relation to observed engagement and propose how this information might be used to inform the development of this app and future research in this nascent field. ", doi="10.2196/43263", url="https://formative.jmir.org/2023/1/e43263", url="http://www.ncbi.nlm.nih.gov/pubmed/36626191" } @Article{info:doi/10.2196/41455, author="Eckhoff, Randall and Boyce, Matthew and Watkins, Lee Rebecca and Kan, Marni and Scaglione, Nichole and Pound, Leah and Root, Meghan", title="Examining the Use of Mobile Technology to Deliver Tailored Sexual Assault Prevention in a Classroom Environment in the Military: Development and Usability Study", journal="JMIR Mhealth Uhealth", year="2022", month="Nov", day="16", volume="10", number="11", pages="e41455", keywords="research techniques", keywords="mobile technology", keywords="tablet", keywords="iPad", keywords="restricted", keywords="resource limited", keywords="Wi-Fi", keywords="tailored learning", keywords="military", keywords="data security", abstract="Background: Advances in mobile technology over the last 10 years have expanded its use in scientific research. However, there are challenges in creating a reliable system for intervention content delivery and data collection in an environment with limited internet connectivity and limited staffing capacity. The Sexual Communication and Consent (SCC) study used tablets to provide individualized Sexual Assault Prevention and Response training in a classroom environment that was both technologically and support staff limited. Objective: We developed the SCC Basic Military Training app and a separate Sexual Assault Response Coordinator app to support individualized training within the new SCC program. This paper presents the functionality, protocols, challenges, and feasibility of deploying mobile technology in an educational environment in the military with limited resources. Methods: We developed both mobile apps targeting the Apple iOS ecosystem. The Basic Military Training app provided a screening instrument that routed the trainee into 1 of 5 specific intervention programs. Over 2 days of basic military training set 2 weeks apart, trainees received a combined 6 hours of program-specific tablet training, combined with universal, interactive classroom training, led by qualified instructors. The Sexual Assault Response Coordinator app, used to deliver supplemental content to a subgroup of trainees, was made available for voluntary and private use at the Sexual Assault Response Coordinator's office on base. All anonymous data were manually transferred onto laptops, where the data were aggregated into files and securely transferred to the project staff for analysis. The study was conducted at the Lackland Air Force Base, Joint Base San Antonio, with 9196 trainees providing the data. Results: A total of 7742 trainees completed both the sessions of the SCC program and a series of evaluative assessments. Some trainees did not receive day 2 training, and only received day 1 training because the COVID-19 pandemic shortened the study period. Of the 190 SCC classes taught, only one class was unable to complete tablet training because of Apple licensing--related technology failure. The 360 study tablets were distributed across 3 classrooms (120 per classroom) and were handled at least 16,938 times with no reports of breakage or requiring replacement. Wi-Fi access limitations exacerbated the complexity of Apple licensing revalidation and the secure transfer of data from the classroom to project personnel. The instructor staff's limited technical knowledge to perform certain technical tasks was challenging. Conclusions: The results demonstrated the feasibility of deploying a mobile app for tablet-based training in a military educational environment. Although successful, the study was not without technical challenges. This paper gives examples of technical lessons learned and recommendations for conducting the study differently, with the aim that the knowledge gained may be helpful to other researchers encountering similar requirements. ", doi="10.2196/41455", url="https://mhealth.jmir.org/2022/11/e41455", url="http://www.ncbi.nlm.nih.gov/pubmed/36383404" } @Article{info:doi/10.2196/36702, author="Broetje, Sylvia and Bauer, F. Georg and Jenny, J. Gregor", title="Acceptance of an Internet-Based Team Development Tool Aimed at Improving Work-Related Well-being in Nurses: Cross-sectional Study", journal="JMIR Nursing", year="2022", month="Apr", day="22", volume="5", number="1", pages="e36702", keywords="digital intervention", keywords="eHealth", keywords="nurses", keywords="online intervention", keywords="organizational health", keywords="technology acceptance", keywords="UTAUT", keywords="workplace health promotion", keywords="mHealth", abstract="Background: Workplace health interventions can produce beneficial health- and business-related outcomes. However, such interventions have traditionally focused on lifestyle behaviors of individuals, mostly not considering the role of working conditions. The wecoach intervention is an internet-based tool that combines both a digital and a participatory team development approach aimed at addressing critical job demands and resources as key aspects of health-promoting working conditions. Nursing staff are particularly affected by challenging working conditions and could potentially benefit greatly. Understanding the acceptance of novel workplace health promotion approaches is a critical precursor to their successful implementation and use. Objective: This study aims to examine the factors influencing the acceptance of a digitally supported team development tool among nurse managers. Methods: A sample of 32 nurse managers from 3 German-speaking countries tested wecoach and completed our online questionnaire. Hypotheses were based on the unified theory of acceptance and use of technology (UTAUT) and the organizational health development (OHD) model and were tested using multiple regression analyses. Results: Our analyses found that merely capacities on the team level (CapTeam) significantly contributed to the acceptance of wecoach, although only after the other variables were excluded in the stepwise multiple regression analysis. The UTAUT predictors were unable to add significant variance explanation beyond that, and their inclusion masked the contribution of CapTeam. Conclusions: For the acceptance of a digitally supported participatory tool, the fit with the team, its culture, and its motivation are of critical importance, while aspects proposed by traditional acceptance models, such as the UTAUT, may not be applicable. ", doi="10.2196/36702", url="https://nursing.jmir.org/2022/1/e36702", url="http://www.ncbi.nlm.nih.gov/pubmed/35452403" } @Article{info:doi/10.2196/29985, author="Garc{\'i}a-S{\'a}nchez, Sebasti{\'a}n and Somoza-Fern{\'a}ndez, Beatriz and de Lorenzo-Pinto, Ana and Ortega-Navarro, Cristina and Herranz-Alonso, Ana and Sanjurjo, Mar{\'i}a", title="Mobile Health Apps Providing Information on Drugs for Adult Emergency Care: Systematic Search on App Stores and Content Analysis", journal="JMIR Mhealth Uhealth", year="2022", month="Apr", day="20", volume="10", number="4", pages="e29985", keywords="emergency drugs", keywords="emergency medicine", keywords="emergency departments", keywords="emergency professionals", keywords="medication errors", keywords="drug characteristics", keywords="drug management", keywords="apps", keywords="mHealth", keywords="mobile health", keywords="digital health", keywords="smartphone", keywords="mobile phone", abstract="Background: Drug-referencing apps are among the most frequently used by emergency health professionals. To date, no study has analyzed the quantity and quality of apps that provide information on emergency drugs. Objective: This study aimed to identify apps designed to assist emergency professionals in managing drugs and to describe and analyze their characteristics. Methods: We performed an observational, cross-sectional, descriptive study of apps that provide information on drugs for adult emergency care. The iOS and Android platforms were searched in February 2021. The apps were independently evaluated by 2 hospital clinical pharmacists. We analyzed developer affiliation, cost, updates, user ratings, and number of downloads. We also evaluated the main topic (emergency drugs or emergency medicine), the number of drugs described, the inclusion of bibliographic references, and the presence of the following drug information: commercial presentations, usual dosage, dose adjustment for renal failure, mechanism of action, therapeutic indications, contraindications, interactions with other medicinal products, use in pregnancy and breastfeeding, adverse reactions, method of preparation and administration, stability data, incompatibilities, identification of high-alert medications, positioning in treatment algorithms, information about medication reconciliation, and cost. Results: Overall, 49 apps were identified. Of these 49 apps, 32 (65\%) were found on both digital platforms; 11 (22\%) were available only for Android, and 6 (12\%) were available only for iOS. In total, 41\% (20/49) of the apps required payment (ranging from {\texteuro}0.59 [US \$0.64] to {\texteuro}179.99 [US \$196.10]) and 22\% (11/49) of the apps were developed by non--health care professionals. The mean weighted user rating was 4.023 of 5 (SD 0.71). Overall, 45\% (22/49) of the apps focused on emergency drugs, and 55\% (27/49) focused on emergency medicine. More than half (29/47, 62\%) did not include bibliographic references or had not been updated for more than a year (29/49, 59\%). The median number of drugs was 66 (range 4 to >5000). Contraindications (26/47, 55\%) and adverse reactions (24/47, 51\%) were found in only half of the apps. Less than half of the apps addressed dose adjustment for renal failure (15/47, 32\%), interactions (10/47, 21\%), and use during pregnancy and breastfeeding (15/47, 32\%). Only 6\% (3/47) identified high-alert medications, and 2\% (1/47) included information about medication reconciliation. Health-related developer, main topic, and greater amount of drug information were not statistically associated with higher user ratings (P=.99, P=.09, and P=.31, respectively). Conclusions: We provide a comprehensive review of apps with information on emergency drugs for adults. Information on authorship, drug characteristics, and bibliographic references is frequently scarce; therefore, we propose recommendations to consider when developing an app of these characteristics. Future efforts should be made to increase the regulation of drug-referencing apps and to conduct a more frequent and documented review of their clinical content. ", doi="10.2196/29985", url="https://mhealth.jmir.org/2022/4/e29985", url="http://www.ncbi.nlm.nih.gov/pubmed/35442212" } @Article{info:doi/10.2196/31392, author="Mageswaran, Nanthini and Ismail, Shareela Noor Akmal", title="Preparing Medical Students for the Final Examinations During the COVID-19 Crisis: A Bumpy Ride to the Finishing Line", journal="JMIR Med Educ", year="2022", month="Feb", day="3", volume="8", number="1", pages="e31392", keywords="COVID-19", keywords="undergraduate medical education", keywords="medical students", keywords="clinical competency", keywords="pandemic", doi="10.2196/31392", url="https://mededu.jmir.org/2022/1/e31392", url="http://www.ncbi.nlm.nih.gov/pubmed/35084354" } @Article{info:doi/10.2196/32017, author="Dederichs, Melina and Nitsch, Jan Felix and Apolin{\'a}rio-Hagen, Jennifer", title="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", journal="JMIR Med Educ", year="2022", month="Jan", day="10", volume="8", number="1", pages="e32017", keywords="participatory design", keywords="co-design", keywords="mHealth", keywords="medical student", keywords="eHealth", keywords="medical education", keywords="mental health", keywords="mobile phone", abstract="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. ", doi="10.2196/32017", url="https://mededu.jmir.org/2022/1/e32017", url="http://www.ncbi.nlm.nih.gov/pubmed/35006085" } @Article{info:doi/10.2196/31559, author="Herrmann-Werner, Anne and Loda, Teresa and Zipfel, Stephan and Holderried, Martin and Holderried, Friederike and Erschens, Rebecca", title="Evaluation of a Language Translation App in an Undergraduate Medical Communication Course: Proof-of-Concept and Usability Study", journal="JMIR Mhealth Uhealth", year="2021", month="Dec", day="2", volume="9", number="12", pages="e31559", keywords="undergraduate medical students", keywords="translation app", keywords="simulation", keywords="physician-patient communication", keywords="mHealth", keywords="mobile applications", keywords="digital health", keywords="app development", keywords="language translation", keywords="translation apps", abstract="Background: Language barriers in medical encounters pose risks for interactions with patients, their care, and their outcomes. Because human translators, the gold standard for mitigating language barriers, can be cost- and time-intensive, mechanical alternatives such as language translation apps (LTA) have gained in popularity. However, adequate training for physicians in using LTAs remains elusive. Objective: A proof-of-concept pilot study was designed to evaluate the use of a speech-to-speech LTA in a specific simulated physician-patient situation, particularly its perceived usability, helpfulness, and meaningfulness, and to assess the teaching unit overall. Methods: Students engaged in a 90-min simulation with a standardized patient (SP) and the LTA iTranslate Converse. Thereafter, they rated the LTA with six items---helpful, intuitive, informative, accurate, recommendable, and applicable---on a 7-point Likert scale ranging from 1 (don't agree at all) to 7 (completely agree) and could provide free-text responses for four items: general impression of the LTA, the LTA's benefits, the LTA's risks, and suggestions for improvement. Students also assessed the teaching unit on a 6-point scale from 1 (excellent) to 6 (insufficient). Data were evaluated quantitatively with mean (SD) values and qualitatively in thematic content analysis. Results: Of 111 students in the course, 76 (68.5\%) participated (59.2\% women, age 20.7 years, SD 3.3 years). Values for the LTA's being helpful (mean 3.45, SD 1.79), recommendable (mean 3.33, SD 1.65) and applicable (mean 3.57, SD 1.85) were centered around the average of 3.5. The items intuitive (mean 4.57, SD 1.74) and informative (mean 4.53, SD 1.95) were above average. The only below-average item concerned its accuracy (mean 2.38, SD 1.36). Students rated the teaching unit as being excellent (mean 1.2, SD 0.54) but wanted practical training with an SP plus a simulated human translator first. Free-text responses revealed several concerns about translation errors that could jeopardize diagnostic decisions. Students feared that patient-physician communication mediated by the LTA could decrease empathy and raised concerns regarding data protection and technical reliability. Nevertheless, they appreciated the LTA's cost-effectiveness and usefulness as the best option when the gold standard is unavailable. They also reported wanting more medical-specific vocabulary and images to convey all information necessary for medical communication. Conclusions: This study revealed the feasibility of using a speech-to-speech LTA in an undergraduate medical course. Although human translators remain the gold standard, LTAs could be valuable alternatives. Students appreciated the simulated teaching and recognized the LTA's potential benefits and risks for use in real-world clinical settings. To optimize patients' and health care professionals' experiences with LTAs, future investigations should examine specific design options for training interventions and consider the legal aspects of human-machine interaction in health care settings. ", doi="10.2196/31559", url="https://mhealth.jmir.org/2021/12/e31559", url="http://www.ncbi.nlm.nih.gov/pubmed/34860678" } @Article{info:doi/10.2196/32356, author="Peng, R. Cynthia and Schertzer, A. Kimberly and Caretta-Weyer, A. Holly and Sebok-Syer, S. Stefanie and Lu, William and Tansomboon, Charissa and Gisondi, A. Michael", title="Assessment of Entrustable Professional Activities Using a Web-Based Simulation Platform During Transition to Emergency Medicine Residency: Mixed Methods Pilot Study", journal="JMIR Med Educ", year="2021", month="Nov", day="17", volume="7", number="4", pages="e32356", keywords="simulation", keywords="graduate medical education", keywords="assessment", keywords="gamification", keywords="entrustable professional activities", keywords="emergency medicine", keywords="undergraduate medical education", abstract="Background: The 13 core entrustable professional activities (EPAs) are key competency-based learning outcomes in the transition from undergraduate to graduate medical education in the United States. Five of these EPAs (EPA2: prioritizing differentials, EPA3: recommending and interpreting tests, EPA4: entering orders and prescriptions, EPA5: documenting clinical encounters, and EPA10: recognizing urgent and emergent conditions) are uniquely suited for web-based assessment. Objective: In this pilot study, we created cases on a web-based simulation platform for the diagnostic assessment of these EPAs and examined the feasibility and acceptability of the platform. Methods: Four simulation cases underwent 3 rounds of consensus panels and pilot testing. Incoming emergency medicine interns (N=15) completed all cases. A maximum of 4 ``look for'' statements, which encompassed specific EPAs, were generated for each participant: (1) performing harmful or missing actions, (2) narrowing differential or wrong final diagnosis, (3) errors in documentation, and (4) lack of recognition and stabilization of urgent diagnoses. Finally, we interviewed a sample of interns (n=5) and residency leadership (n=5) and analyzed the responses using thematic analysis. Results: All participants had at least one missing critical action, and 40\% (6/15) of the participants performed at least one harmful action across all 4 cases. The final diagnosis was not included in the differential diagnosis in more than half of the assessments (8/15, 54\%). Other errors included selecting incorrect documentation passages (6/15, 40\%) and indiscriminately applying oxygen (9/15, 60\%). The interview themes included psychological safety of the interface, ability to assess learning, and fidelity of cases. The most valuable feature cited was the ability to place orders in a realistic electronic medical record interface. Conclusions: This study demonstrates the feasibility and acceptability of a web-based platform for diagnostic assessment of specific EPAs. The approach rapidly identifies potential areas of concern for incoming interns using an asynchronous format, provides feedback in a manner appreciated by residency leadership, and informs individualized learning plans. ", doi="10.2196/32356", url="https://mededu.jmir.org/2021/4/e32356", url="http://www.ncbi.nlm.nih.gov/pubmed/34787582" } @Article{info:doi/10.2196/17472, author="Follmann, Andreas and Ruhl, Alexander and G{\"o}sch, Michael and Felzen, Marc and Rossaint, Rolf and Czaplik, Michael", title="Augmented Reality for Guideline Presentation in Medicine: Randomized Crossover Simulation Trial for Technically Assisted Decision-making", journal="JMIR Mhealth Uhealth", year="2021", month="Oct", day="18", volume="9", number="10", pages="e17472", keywords="augmented reality", keywords="smart glasses", keywords="wearables", keywords="guideline presentation", keywords="decision support", keywords="triage", abstract="Background: Guidelines provide instructions for diagnostics and therapy in modern medicine. Various mobile devices are used to represent the potential complex decision trees. An example of time-critical decisions is triage in case of a mass casualty incident. Objective: In this randomized controlled crossover study, the potential of augmented reality for guideline presentation was evaluated and compared with the guideline presentation provided in a tablet PC as a conventional device. Methods: A specific Android app was designed for use with smart glasses and a tablet PC for the presentation of a triage algorithm as an example for a complex guideline. Forty volunteers simulated a triage based on 30 fictional patient descriptions, each with technical support from smart glasses and a tablet PC in a crossover trial design. The time to come to a decision and the accuracy were recorded and compared between both devices. Results: A total of 2400 assessments were performed by the 40 volunteers. A significantly faster time to triage was achieved in total with the tablet PC (median 12.8 seconds, IQR 9.4-17.7; 95\% CI 14.1-14.9) compared to that to triage with smart glasses (median 17.5 seconds, IQR 13.2-22.8, 95\% CI 18.4-19.2; P=.001). Considering the difference in the triage time between both devices, the additional time needed with the smart glasses could be reduced significantly in the course of assessments (21.5 seconds, IQR 16.5-27.3, 95\% CI 21.6-23.2) in the first run, 17.4 seconds (IQR 13-22.4, 95\% CI 17.6-18.9) in the second run, and 14.9 seconds (IQR 11.7-18.6, 95\% CI 15.2-16.3) in the third run (P=.001). With regard to the accuracy of the guideline decisions, there was no significant difference between both the devices. Conclusions: The presentation of a guideline on a tablet PC as well as through augmented reality achieved good results. The implementation with smart glasses took more time owing to their more complex operating concept but could be accelerated in the course of the study after adaptation. Especially in a non--time-critical working area where hands-free interfaces are useful, a guideline presentation with augmented reality can be of great use during clinical management. ", doi="10.2196/17472", url="https://mhealth.jmir.org/2021/10/e17472", url="http://www.ncbi.nlm.nih.gov/pubmed/34661548" } @Article{info:doi/10.2196/29899, author="Toto, L. Regina and Vorel, S. Ethan and Tay, E. Khoon-Yen and Good, L. Grace and Berdinka, M. Jesse and Peled, Adam and Leary, Marion and Chang, P. Todd and Weiss, K. Anna and Balamuth, B. Frances", title="Augmented Reality in Pediatric Septic Shock Simulation: Randomized Controlled Feasibility Trial", journal="JMIR Med Educ", year="2021", month="Oct", day="6", volume="7", number="4", pages="e29899", keywords="augmented reality", keywords="simulation", keywords="septic shock", keywords="children", keywords="pediatrics", keywords="simulation-based education", keywords="application", keywords="fluid administration", abstract="Background: Septic shock is a low-frequency but high-stakes condition in children requiring prompt resuscitation, which makes it an important target for simulation-based education. Objective: In this study, we aimed to design and implement an augmented reality app (PediSepsisAR) for septic shock simulation, test the feasibility of measuring the timing and volume of fluid administration during septic shock simulation with and without PediSepsisAR, and describe PediSepsisAR as an educational tool. We hypothesized that we could feasibly measure our desired data during the simulation in 90\% of the participants in each group. With regard to using PediSepsisAR as an educational tool, we hypothesized that the PediSepsisAR group would report that it enhanced their awareness of simulated patient blood flow and would more rapidly verbalize recognition of abnormal patient status and desired management steps. Methods: We performed a randomized controlled feasibility trial with a convenience sample of pediatric care providers at a large tertiary care pediatric center. Participants completed a prestudy questionnaire and were randomized to either the PediSepsisAR or control (traditional simulation) arms. We measured the participants' time to administer 20, 40, and 60 cc/kg of intravenous fluids during a septic shock simulation using each modality. In addition, facilitators timed how long participants took to verbalize they had recognized tachycardia, hypotension, or septic shock and desired to initiate the sepsis pathway and administer antibiotics. Participants in the PediSepsisAR arm completed a poststudy questionnaire. We analyzed data using descriptive statistics and a Wilcoxon rank-sum test to compare the median time with event variables between groups. Results: We enrolled 50 participants (n=25 in each arm). The timing and volume of fluid administration were captured in all the participants in each group. There was no statistically significant difference regarding time to administration of intravenous fluids between the two groups. Similarly, there was no statistically significant difference between the groups regarding time to verbalized recognition of patient status or desired management steps. Most participants in the PediSepsisAR group reported that PediSepsisAR enhanced their awareness of the patient's perfusion. Conclusions: We developed an augmented reality app for use in pediatric septic shock simulations and demonstrated the feasibility of measuring the volume and timing of fluid administration during simulation using this modality. In addition, our findings suggest that PediSepsisAR may enhance participants' awareness of abnormal perfusion. ", doi="10.2196/29899", url="https://mededu.jmir.org/2021/4/e29899", url="http://www.ncbi.nlm.nih.gov/pubmed/34612836" } @Article{info:doi/10.2196/24182, author="Hicks, Paul Joseph and Allsop, John Matthew and Akaba, O. Godwin and Yalma, M. Ramsey and Dirisu, Osasuyi and Okusanya, Babasola and Tukur, Jamilu and Okunade, Kehinde and Akeju, David and Ajepe, Adegbenga and Okuzu, Okey and Mirzoev, Tolib and Ebenso, Bassey", title="Acceptability and Potential Effectiveness of eHealth Tools for Training Primary Health Workers From Nigeria at Scale: Mixed Methods, Uncontrolled Before-and-After Study", journal="JMIR Mhealth Uhealth", year="2021", month="Sep", day="16", volume="9", number="9", pages="e24182", keywords="primary health worker training", keywords="digital health technology", keywords="eHealth", keywords="video-based training", keywords="maternal and child health", keywords="Nigeria", keywords="mobile phone", abstract="Background: The in-service training of frontline health workers (FHWs) in primary health care facilities plays an important role in improving the standard of health care delivery. However, it is often expensive and requires FHWs to leave their posts in rural areas to attend courses in urban centers. This study reports the implementation of a digital health tool for providing video training (VTR) on maternal, newborn, and child health (MNCH) care to provide in-service training at scale without interrupting health services. The VTR intervention was supported by satellite communications technology and existing 3G mobile networks. Objective: This study aims to determine the feasibility and acceptability of these digital health tools and their potential effectiveness in improving clinical knowledge, attitudes, and practices related to MNCH care. Methods: A mixed methods design, including an uncontrolled pre- and postquantitative evaluation, was adopted. From October 2017 to May 2018, a VTR mobile intervention was delivered to FHWs in 3 states of Nigeria. We examined changes in workers' knowledge and confidence in delivering MNCH services through a pre- and posttest survey. Stakeholders' experiences with the intervention were explored through semistructured interviews that drew on the technology acceptance model to frame contextual factors that shaped the intervention's acceptability and usability in the work environment. Results: In total, 328 FHWs completed both pre- and posttests. FHWs achieved a mean pretest score of 51\% (95\% CI 48\%-54\%) and mean posttest score of 69\% (95\% CI 66\%-72\%), reflecting, after adjusting for key covariates, a mean increase between the pre- and posttest of 17 percentage points (95\% CI 15-19; P<.001). Variation was identified in pre- and posttest scores by the sex and location of participants alongside topic-specific areas where scores were lowest. Stakeholder interviews suggested a wide acceptance of VTR Mobile (delivered via digital technology) as an important tool for enhancing the quality of training, reinforcing knowledge, and improving health outcomes. Conclusions: This study found that VTR supported through a digital technology approach is a feasible and acceptable approach for supporting improvements in clinical knowledge, attitudes, and reported practices in MNCH. The determinants of technology acceptance included ease of use, perceived usefulness, access to technology and training contents, and the cost-effectiveness of VTR, whereas barriers to the adoption of VTR were poor electricity supply, poor internet connection, and FHWs' workload. The evaluation also identified the mechanisms of the impact of delivering VTR Mobile at scale on the micro (individual), meso (organizational), and macro (policy) levels of the health system. Future research is required to explore the translation of this digital health approach for the VTR of FHWs and its impact across low-resource settings to ameliorate the financial and time costs of training and support high-quality MNCH care delivery. Trial Registration: ISRCTN Registry 32105372; https://www.isrctn.com/ISRCTN32105372 ", doi="10.2196/24182", url="https://mhealth.jmir.org/2021/9/e24182", url="http://www.ncbi.nlm.nih.gov/pubmed/34528891" } @Article{info:doi/10.2196/29498, author="Liu, Fang and Weng, Huiting and Xu, Rong and Li, Xia and Zhang, Zhe and Zhao, Kuaile and Zhou, Zhiguang and Wang, Qin", title="Nursing Interns' Attitudes Toward, Preferences for, and Use of Diabetes Virtual Simulation Teaching Applications in China: National Web-Based Survey", journal="JMIR Mhealth Uhealth", year="2021", month="Sep", day="9", volume="9", number="9", pages="e29498", keywords="nursing interns", keywords="virtual simulation", keywords="China", keywords="nursing education", keywords="diabetes", abstract="Background: Diabetes has placed heavy social and economic burdens on society and families worldwide. Insufficient knowledge and training of frontline medical staff, such as nurses, interns, and residents, may lead to an increase in acute and chronic complications among patients with diabetes. However, interns have insufficient knowledge about diabetes management. The factors that affect interns' current level of diabetes-related knowledge are still unclear. Therefore, understanding the behavioral intentions of interns is essential to supporting the development and promotion of the use of virtual simulation teaching applications. Objective: This study aimed to identify the determinants of nursing interns' intentions to use simulation-based education applications. Methods: From December 1, 2020, to February 28, 2021, the web-based survey tool Sojump (Changsha Xingxin Information Technology Co) was used to survey nursing interns in hospitals across China. Two survey links were sent to 37 partner schools in 23 major cities in China, and they were disseminated through participants' WeChat networks. Multiple regression analysis was used to determine the association between demographic information and basic disease information and the use of the application for treating adult patients. Results: Overall, 883 nursing interns from 23 provinces in China responded to the survey. Among them, the virtual simulation utilization rate was 35.6\% (314/883) and the awareness rate was 10.2\% (90/883). In addition, among the interns, only 10.2\% (90/883) correctly understood the concept of virtual simulation, and most of them (793/883, 89.8\%) believed that scenario-simulation training or the use of models for teaching are all the same. Multiple regression analysis showed that the educational level, independent learning ability, and professional identity of the interns were related to use of the application (P<.05). Skills and knowledge that the interns most wanted to acquire included the treatment of hypoglycemia (626/883, 70.9\%), functional test simulation (610/883, 69.1\%), and blood glucose monitoring technology (485/883, 54.9\%). A total of 60.5\% (534/883) of the interns wanted to acquire clinical thinking skills, while 16.0\% (141/883) wanted to acquire operational skills. Nursing trainees believed that the greatest obstacles to virtual simulation included limited time (280/883, 31.7\%), the degree of simulation (129/883, 14.6\%), the demand for satisfaction (108/883, 12.2\%), and test scores (66/883, 7.5\%). Conclusions: The understanding and usage rate of diabetes virtual simulation teaching applications by Chinese nursing interns is very low. However, they have high requirements regarding this teaching method. Conducting high-quality randomized controlled trials and designing applications that are suitable for the needs of different nurse trainees will increase students' interest in learning and help improve diabetes knowledge among nursing interns. ", doi="10.2196/29498", url="https://mhealth.jmir.org/2021/9/e29498", url="http://www.ncbi.nlm.nih.gov/pubmed/34499047" } @Article{info:doi/10.2196/27901, author="Lin, Yuchen and Neuschaefer-Rube, Christiane", title="Digital Learning in Speech-Language Pathology, Phoniatrics, and Otolaryngology: Interdisciplinary and Exploratory Analysis of Content, Organizing Structures, and Formats", journal="JMIR Med Educ", year="2021", month="Jul", day="27", volume="7", number="3", pages="e27901", keywords="digital learning", keywords="e-learning", keywords="speech-language pathology", keywords="phoniatrics", keywords="otolaryngology", keywords="communication disorders", keywords="mobile phone", abstract="Background: The digital revolution is rapidly transforming health care and clinical teaching and learning. Relative to other medical fields, the interdisciplinary fields of speech-language pathology (SLP), phoniatrics, and otolaryngology have been slower to take up digital tools for therapeutic, teaching, and learning purposes---a process that was recently expedited by the COVID-19 pandemic. Although many current teaching and learning tools have restricted or institution-only access, there are many openly accessible tools that have gone largely unexplored. To find, use, and evaluate such resources, it is important to be familiar with the structures, concepts, and formats of existing digital tools. Objective: This descriptive study aims to investigate digital learning tools and resources in SLP, phoniatrics, and otolaryngology. Differences in content, learning goals, and digital formats between academic-level learners and clinical-professional learners are explored. Methods: A systematic search of generic and academic search engines (eg, Google and PubMed); the App Store; Google Play Store; and websites of established SLP, phoniatrics, and otolaryngology organizations was conducted. By using specific search terms and detailed inclusion and exclusion criteria, relevant digital resources were identified. These were organized and analyzed according to learner groups, content matter, learning goals and architectures, and digital formats. Results: Within- and between-learner group differences among 125 identified tools were investigated. In terms of content, the largest proportion of tools for academic-level learners pertained to anatomy and physiology (60/214, 28\%), and that for clinical-professional learners pertained to diagnostic evaluation (47/185, 25.4\%). Between groups, the largest differences were observed for anatomy and physiology (academic-level learners: 60/86, 70\%; clinical-professional learners: 26/86, 30\%) and professional issues (8/28, 29\% vs 20/28, 71\%). With regard to learning goals, most tools for academic-level learners targeted the performance of procedural skills (50/98, 51\%), and those for clinical-professional learners targeted receptive information acquisition (44/62, 71\%). Academic-level learners had more tools for supporting higher-level learning goals than clinical-professional learners, specifically tools for performing procedural skills (50/66, 76\% vs 16/66, 24\%) and strategic skills (8/10, 80\% vs 2/10, 20\%). Visual formats (eg, pictures or diagrams) were dominant across both learner groups. The greatest between-group differences were observed for interactive formats (45/66, 68\% vs 21/66, 32\%). Conclusions: This investigation provides initial insights into openly accessible tools across SLP, phoniatrics, and otolaryngology and their organizing structures. Digital tools in these fields addressed diverse content, although the tools for academic-level learners were greater in number, targeted higher-level learning goals, and had more interactive formats than those for clinical-professional learners. The crucial next steps include investigating the actual use of such tools in practice and students' and professionals' attitudes to better improve upon such tools and incorporate them into current and future learning milieus. ", doi="10.2196/27901", url="https://mededu.jmir.org/2021/3/e27901", url="http://www.ncbi.nlm.nih.gov/pubmed/34313592" } @Article{info:doi/10.2196/25437, author="Fija{\v c}ko, Nino and Masterson Creber, Ruth and Gosak, Lucija and {\vS}tiglic, Gregor and Egan, Dominic and Chaka, Brian and Debeljak, Nika and Strnad, Matej and Skok, Pavel", title="Evaluating Quality, Usability, Evidence-Based Content, and Gamification Features in Mobile Learning Apps Designed to Teach Children Basic Life Support: Systematic Search in App Stores and Content Analysis", journal="JMIR Mhealth Uhealth", year="2021", month="Jul", day="20", volume="9", number="7", pages="e25437", keywords="cardiopulmonary resuscitation", keywords="basic life support", keywords="mobile learning", keywords="mobile phone", keywords="gamification", keywords="schoolchildren", abstract="Background: Globally, 3.7 million people die of sudden cardiac death annually. Following the World Health Organization endorsement of the Kids Save Lives statements, initiatives to train school-age children in basic life support (BLS) have been widespread. Mobile phone apps, combined with gamification, represent an opportunity for including mobile learning (m-learning) in teaching schoolchildren BLS as an additional teaching method; however, the quality of these apps is questionable. Objective: This study aims to systematically evaluate the quality, usability, evidence-based content, and gamification features (GFs) of commercially available m-learning apps for teaching guideline-directed BLS knowledge and skills to school-aged children. Methods: We searched the Google Play Store and Apple iOS App Store using multiple terms (eg, cardiopulmonary resuscitation [CPR] or BLS). Apps meeting the inclusion criteria were evaluated by 15 emergency health care professionals using the user version of the Mobile Application Rating Scale and System Usability Scale. We modified a five-finger mnemonic for teaching schoolchildren BLS and reviewed the apps' BLS content using standardized criteria based on three CPR guidelines. GFs in the apps were evaluated using a gamification taxonomy. Results: Of the 1207 potentially relevant apps, only 6 (0.49\%) met the inclusion criteria. Most apps were excluded because the content was not related to teaching schoolchildren BLS. The mean total scores for the user version of the Mobile Application Rating Scale and System Usability Scale score were 3.2/5 points (95\% CI 3.0-3.4) and 47.1/100 points (95\% CI 42.1-52.1), respectively. Half of the apps taught hands-only CPR, whereas the other half also included ventilation. All the apps indicated when to start chest compressions, and only 1 app taught BLS using an automated external defibrillator. Gamification was well integrated into the m-learning apps for teaching schoolchildren BLS, whereas the personal and fictional, educational, and performance gamification groups represented most GFs. Conclusions: Improving the quality and usability of BLS content in apps and combining them with GFs can offer educators novel m-learning tools to teach schoolchildren BLS skills. ", doi="10.2196/25437", url="https://mhealth.jmir.org/2021/7/e25437", url="http://www.ncbi.nlm.nih.gov/pubmed/34283034" } @Article{info:doi/10.2196/23835, author="Klemm, Philipp and Kleyer, Arnd and Tascilar, Koray and Schuster, Louis and Meinderink, Timo and Steiger, Florian and Lange, Uwe and M{\"u}ller-Ladner, Ulf and Knitza, Johannes and Sewerin, Philipp and Mucke, Johanna and Pfeil, Alexander and Schett, Georg and Hartmann, Fabian and Hueber, J. Axel and Simon, David", title="A Virtual Reality--Based App to Educate Health Care Professionals and Medical Students About Inflammatory Arthritis: Feasibility Study", journal="JMIR Serious Games", year="2021", month="May", day="11", volume="9", number="2", pages="e23835", keywords="feasibility", keywords="virtual reality", keywords="inflammatory arthritis", keywords="psoriatic arthritis", keywords="rheumatoid arthritis", abstract="Background: Inflammatory arthritides (IA) such as rheumatoid arthritis or psoriatic arthritis are disorders that can be difficult to comprehend for health professionals and students in terms of the heterogeneity of clinical symptoms and pathologies. New didactic approaches using innovative technologies such as virtual reality (VR) apps could be helpful to demonstrate disease manifestations as well as joint pathologies in a more comprehensive manner. However, the potential of using a VR education concept in IA has not yet been evaluated. Objective: We evaluated the feasibility of a VR app to educate health care professionals and medical students about IA. Methods: We developed a VR app using data from IA patients as well as 2D and 3D-visualized pathological joints from X-ray and computed tomography--generated images. This VR app (Rheumality) allows the user to interact with representative arthritic joint and bone pathologies of patients with IA. In a consensus meeting, an online questionnaire was designed to collect basic demographic data (age, sex); profession of the participants; and their feedback on the general impression, knowledge gain, and potential areas of application of the VR app. The VR app was subsequently tested and evaluated by health care professionals (physicians, researchers, and other professionals) and medical students at predefined events (two annual rheumatology conferences and academic teaching seminars at two sites in Germany). To explore associations between categorical variables, the $\chi$2 or Fisher test was used as appropriate. Two-sided P values ?.05 were regarded as significant. Results: A total of 125 individuals participated in this study. Among them, 56\% of the participants identified as female, 43\% identified as male, and 1\% identified as nonbinary; 59\% of the participants were 18-30 years of age, 18\% were 31-40 years old, 10\% were 41-50 years old, 8\% were 51-60 years old, and 5\% were 61-70 years old. The participants (N=125) rated the VR app as excellent, with a mean rating of 9.0 (SD 1.2) out of 10, and many participants would recommend use of the app, with a mean recommendation score of 3.2 (SD 1.1) out of 4. A large majority (120/125, 96.0\%) stated that the presentation of pathological bone formation improves understanding of the disease. We did not find any association between participant characteristics and evaluation of the VR experience or recommendation scores. Conclusions: The data show that IA-targeting innovative teaching approaches based on VR technology are feasible. ", doi="10.2196/23835", url="https://games.jmir.org/2021/2/e23835", url="http://www.ncbi.nlm.nih.gov/pubmed/33973858" } @Article{info:doi/10.2196/25377, author="Gladman, Tehmina and Tylee, Grace and Gallagher, Steve and Mair, Jonathan and Grainger, Rebecca", title="Measuring the Quality of Clinical Skills Mobile Apps for Student Learning: Systematic Search, Analysis, and Comparison of Two Measurement Scales", journal="JMIR Mhealth Uhealth", year="2021", month="Apr", day="23", volume="9", number="4", pages="e25377", keywords="mobile apps", keywords="MARS", keywords="MARuL", keywords="medical education", keywords="app review", keywords="mobile phone", abstract="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. ", doi="10.2196/25377", url="https://mhealth.jmir.org/2021/4/e25377", url="http://www.ncbi.nlm.nih.gov/pubmed/33890859" } @Article{info:doi/10.2196/22633, author="Egilsdottir, {\"O}sp H. and Heyn, G{\"u}nterberg Lena and Brembo, Andreas Espen and Byermoen, R{\o}land Kirsten and Moen, Anne and Eide, Hilde", title="Configuration of Mobile Learning Tools to Support Basic Physical Assessment in Nursing Education: Longitudinal Participatory Design Approach", journal="JMIR Mhealth Uhealth", year="2021", month="Jan", day="7", volume="9", number="1", pages="e22633", keywords="learning", keywords="mobile phone", keywords="mobile application", keywords="education, nursing", keywords="students, nursing", keywords="education, clinical", keywords="nursing skills", keywords="physical examination", keywords="computer simulation", keywords="clinical competence", abstract="Background: As many students in higher education are skilled users of mobile technology, mobile learning (mLearning) can be a promising educational strategy to enhance their learning experience. mLearning might also be well suited for nursing students as they navigate between multiple learning contexts in their educational curriculum. As an educational strategy, mLearning may also reduce challenges caused by the theory-practice gap in nursing by supporting skills and knowledge transfer between the university and clinical settings. As the introduction of basic physical assessment skills (B-PASs) into Norwegian bachelor's degree education in nursing occurred quite recently, there is a lack of competence in supervision and teaching in both university and clinical settings. As such, mLearning appears to be a good strategy to support student B-PAS learning and knowledge transfer across learning contexts. Objective: This study aims to explore and elicit the perspectives of students regarding the way in which a selection of digital learning resources supports B-PAS learning and application in clinical rotation, which of the selected digital learning resources are beneficial to include in a suite of mLearning tools, and how the selected digital learning resources could support the transfer of skills and knowledge from the academic to clinical context. Methods: We used a longitudinal participatory design approach to co-design a suite of mLearning tools. The co-design processes took place in several workshops (WSs) over a period of 3 months: 2 WSs with first-year students (n=6), 3 WSs with second-year students (n=6), and 3 WSs with third-year students (n=8). The students evaluated several digital learning resources in both academic and clinical contexts. The digital learning resources included digital simulation with virtual patients, massive open online courses, and multimedia learning material. In the co-design WS, the potential and benefits of these digital learning resources for the learning and application of B-PASs were explored. Results: The students reported that the digital learning resources stimulated learning in 7 different ways. They also emphasized the importance of including all selected and tested digital learning resources. Moreover, students supported the inclusion of additional learning material, such as multiple-choice tests and written assignments, aimed at providing feedback and contributing to knowledge development. Conclusions: The co-design processes and collaboration with the nursing students provided insight into how a suite of mLearning tools may support the learning and application of B-PASs and human bioscience knowledge in clinical rotation. From the students' perspective, one of the strengths of the suite of mLearning tools was the range of content, as this met a broader range of student learning preferences regarding learning B-PASs. The suite of mLearning tools contributes to and supports skills training and knowledge transfer between multiple learning contexts. ", doi="10.2196/22633", url="https://mhealth.jmir.org/2021/1/e22633", url="http://www.ncbi.nlm.nih.gov/pubmed/33410756" } @Article{info:doi/10.2196/19780, author="Yuliawan, Deny and Widyandana, Doni and Nur Hidayah, Rachmadya", title="Utilization of Nursing Education Progressive Web Application (NEPWA) Media in an Education and Health Promotion Course Using Gagne's Model of Instructional Design on Nursing Students: Quantitative Research and Development Study", journal="JMIR Nursing", year="2020", month="Nov", day="13", volume="3", number="1", pages="e19780", keywords="mobile application", keywords="nursing students", keywords="blended learning", keywords="knowledge", keywords="satisfaction", keywords="system usability", keywords="mobile phone", abstract="Background: Previous studies have proven that web-based learning media that offer interesting features with the learning management system concept could support the learning processes of nursing students. Nonetheless, it is still necessary to conduct further research on its potential as an information media that supports learning using 1 of the mobile learning methods. Objective: This study aims to develop and use the Nursing Education Progressive Web Application (NEPWA) media in an education and health promotion course for nursing students. Methods: This is a research and development study aimed at developing the NEPWA media using the Analyze, Design, Develop, Implement, and Evaluate approach and a quantitative research with descriptive and pre-experimental 1-group pretest-posttest design conducted in the Study Program of Nursing Sciences, Faculty of Health Sciences, Muhammadiyah University of Surakarta. A total of 39 nursing students in their second year of undergraduate studies participated in this study. A pretest-posttest design was used to measure any changes in the dependent variable, whereas a posttest design was used to measure any changes in the independent variables. Results: After using the NEPWA media, there was a significant increase in the student knowledge variable (N=39; knowledge: P<.001; 95\% CI 23.88-33.14). In terms of student satisfaction with the learning process using Gagne's model of instructional design, most of the students were satisfied, with a mean score of ?3. In addition, the results of the measurement using the System Usability Scale on the NEPWA media showed that NEPWA has good usability and it is acceptable by users, with a mean score of 72.24 (SD 8.54). Conclusions: The NEPWA media can be accepted by users and has good usability, and this media is designed to enhance student knowledge. ", doi="10.2196/19780", url="https://nursing.jmir.org/2020/1/e19780/", url="http://www.ncbi.nlm.nih.gov/pubmed/34345790" } @Article{info:doi/10.2196/19072, author="Johnson, Gr{\o}dem Susanne and Potrebny, Thomas and Larun, Lillebeth and Ciliska, Donna and Olsen, Rydland Nina", title="Usability Methods and Attributes Reported in Usability Studies of Mobile Apps for Health Care Education: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2020", month="Aug", day="4", volume="9", number="8", pages="e19072", keywords="user-computer interface", keywords="mobile app", keywords="online learning", keywords="health education", keywords="students", abstract="Background: E-learning technologies, including mobile apps, are used to a large extent in health care education. Mobile apps can provide extendable learning environments and motivate students for adaptive and collaborative learning outside the classroom context. Developers should design practical, effective, and easy-to-use mobile apps. Usability testing is an important part of app development in order to understand if apps meet the needs of users. Objective: The aim of this study is to perform a scoping review of usability methods and attributes reported in usability studies of mobile apps for health care education. Methods: The scoping review is guided by the methodological framework developed by Arksey \& O'Malley and further developed by Levac et al and Kahlil et al. The stages we will follow are as follows: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) summarizing and reporting the results. We have developed two research questions to meet the aim of the study, which are as follows: (1) What usability methods are used to evaluate the usability of mobile apps for health care education? and (2) What usability attributes are reported in the usability studies of mobile apps for health care education? We will apply a comprehensive search of the literature, including 10 databases, a reference search, and a search for grey literature. Two review authors will independently screen articles for eligibility. Results: The initial electronic database searches were completed in March 2019. The literature search identified 14,297 unique references. Following title and abstract screening, the full texts of 369 records were obtained. The scoping review is expected to be completed in spring 2021. Conclusions: We expect the overview of usability methods and attributes reported in usability studies of mobile apps for health care education to contribute to the knowledge base for researchers and developers. It will give an overview of the research field and provide researchers and developers with relevant and important information on the usability research area, including highlighting possible research gaps. International Registered Report Identifier (IRRID): DERR1-10.2196/19072 ", doi="10.2196/19072", url="https://www.researchprotocols.org/2020/8/e19072", url="http://www.ncbi.nlm.nih.gov/pubmed/32750011" } @Article{info:doi/10.2196/18015, author="Gladman, Tehmina and Tylee, Grace and Gallagher, Steve and Mair, Jonathan and Rennie, C. Sarah and Grainger, Rebecca", title="A Tool for Rating the Value of Health Education Mobile Apps to Enhance Student Learning (MARuL): Development and Usability Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="31", volume="8", number="7", pages="e18015", keywords="questionnaire design", keywords="medical education", keywords="health occupations students", keywords="just-in-time learning", keywords="self-directed learning", keywords="mobile phone", keywords="rubric", keywords="mobile learning", keywords="mobile apps", keywords="mhealth", keywords="digital learning", abstract="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 ($\alpha$=.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. ", doi="10.2196/18015", url="https://mhealth.jmir.org/2020/7/e18015", url="http://www.ncbi.nlm.nih.gov/pubmed/32735228" } @Article{info:doi/10.2196/17729, author="Zamberg, Ido and Windisch, Olivier and Agoritsas, Thomas and Nendaz, Mathieu and Savoldelli, Georges and Schiffer, Eduardo", title="A Mobile Medical Knowledge Dissemination Platform (HeadToToe): Mixed Methods Study", journal="JMIR Med Educ", year="2020", month="May", day="27", volume="6", number="1", pages="e17729", keywords="clinical skills", keywords="clinical competence", keywords="clinical practice guidelines", keywords="medical education", keywords="smartphone", keywords="innovation", keywords="medical guidance", keywords="mobile phone", abstract="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. ", doi="10.2196/17729", url="http://mededu.jmir.org/2020/1/e17729/", url="http://www.ncbi.nlm.nih.gov/pubmed/32249758" } @Article{info:doi/10.2196/17101, author="Lozano-Lozano, Mario and Fern{\'a}ndez-Lao, Carolina and Cantarero-Villanueva, Irene and Noguerol, Ignacio and {\'A}lvarez-Salvago, Francisco and Cruz-Fern{\'a}ndez, Mayra and Arroyo-Morales, Manuel and Galiano-Castillo, Noelia", title="A Blended Learning System to Improve Motivation, Mood State, and Satisfaction in Undergraduate Students: Randomized Controlled Trial", journal="J Med Internet Res", year="2020", month="May", day="22", volume="22", number="5", pages="e17101", keywords="learning", keywords="teaching", keywords="students, health occupations", keywords="mobile apps", keywords="education", abstract="Background: Smartphone-based learning, or mobile learning (m-learning), has become a popular learning-and-teaching strategy in educational environments. Blended learning combines strategies such as m-learning with conventional learning to offer continuous training, anytime and anywhere, via innovative learning activities. Objective: The main aim of this work was to examine the short-term (ie, 2-week) effects of a blended learning method using traditional materials plus a mobile app---the iPOT mobile learning app---on knowledge, motivation, mood state, and satisfaction among undergraduate students enrolled in a health science first-degree program. Methods: The study was designed as a two-armed, prospective, single-blind, randomized controlled trial. Subjects who met the inclusion criteria were randomly assigned to either the intervention group (ie, blended learning involving traditional lectures plus m-learning via the use of the iPOT app) or the control group (ie, traditional on-site learning). For both groups, the educational program involved 13 lessons on basic health science. The iPOT app is a hybrid, multiplatform (ie, iOS and Android) smartphone app with an interactive teacher-student interface. Outcomes were measured via multiple-choice questions (ie, knowledge), the Instructional Materials Motivation Survey (ie, motivation), the Profile of Mood States scale (ie, mood state), and Likert-type questionnaires (ie, satisfaction and linguistic competence). Results: A total of 99 students were enrolled, with 49 (49\%) in the intervention group and 50 (51\%) in the control group. No difference was seen between the two groups in terms of theoretical knowledge gain (P=.92). However, the intervention group subjects returned significantly higher scores than the control group subjects for all postintervention assessed items via the motivation questionnaire (all P<.001). Analysis of covariance (ANCOVA) revealed a significant difference in the confusion and bewilderment component in favor of the intervention group (P=.01), but only a trend toward significance in anger and hostility as well as total score. The intervention group subjects were more satisfied than the members of the control group with respect to five out of the six items evaluated: general satisfaction (P<.001), clarity of the instructions (P<.01), clarity with the use of the learning method (P<.001), enough time to complete the proposed exercises (P<.01), and improvement in the capacity to learn content (P<.001). Finally, the intervention group subjects who were frequent users of the app showed stronger motivation, as well as increased perception of greater gains in their English-language competence, than did infrequent users. Conclusions: The blended learning method led to significant improvements in motivation, mood state, and satisfaction compared to traditional teaching, and elicited statements of subjective improvement in terms of competence in English. Trial Registration: ClinicalTrials.gov NCT03335397; https://clinicaltrials.gov/ct2/show/NCT03335397 ", doi="10.2196/17101", url="http://www.jmir.org/2020/5/e17101/", url="http://www.ncbi.nlm.nih.gov/pubmed/32441655" } @Article{info:doi/10.2196/15762, author="Hejjaji, Vittal and Malik, O. Ali and Peri-Okonny, A. Poghni and Thomas, Merrill and Tang, Yuanyuan and Wooldridge, David and Spertus, A. John and Chan, S. Paul", title="Mobile App to Improve House Officers' Adherence to Advanced Cardiac Life Support Guidelines: Quality Improvement Study", journal="JMIR Mhealth Uhealth", year="2020", month="May", day="19", volume="8", number="5", pages="e15762", keywords="cardiac arrest", keywords="advanced cardiac life support", keywords="mHealth", keywords="quality improvement", keywords="medical education", abstract="Background: Effective and timely delivery of cardiac arrest interventions during in-hospital cardiac arrest resuscitation is associated with greater survival. Whether a mobile app that provides timely reminders of critical interventions improves adherence to Advanced Cardiovascular Life Support (ACLS) guidelines among house officers, who may lack experience in leading resuscitations, remains unknown. Objective: The aim of this study was to assess the impact of a commercially available, dynamic mobile app on house officers' adherence to ACLS guidelines. Methods: As part of a quality improvement initiative, internal medicine house officers were invited to participate and randomized to lead 2 consecutive cardiac arrest simulations, one with a novel mobile app and one without a novel mobile app. All simulations included 4 cycles of cardiopulmonary resuscitation with different cardiac arrest rhythms and were video recorded. The coprimary end points were chest compression fraction and number of correct interventions in each simulation. The secondary end point was incorrect interventions, defined as interventions not indicated by the 2015 ACLS guidelines. Paired t tests compared performance with and without the mobile app. Results: Among 53 house officers, 26 house officers were randomized to lead the first simulation with the mobile app, and 27 house officers were randomized to do so without the app. Use of the mobile app was associated with a higher number of correct ACLS interventions (out of 7; mean 6.2 vs 5.1; absolute difference 1.1 [95\% CI 0.6 to 1.6]; P<.001) as well as fewer incorrect ACLS interventions (mean 0.3 vs 1.0; absolute difference --0.7 [95\% CI --0.3 to --1.0]; P<.001). Simulations with the mobile app also had a marginally higher chest compression fraction (mean 90.9\% vs 89.0\%; absolute difference 1.9\% [95\% CI 0.6\% to 3.4\%]; P=.007). Conclusions: This proof-of-concept study suggests that this novel mobile app may improve adherence to ACLS protocols, but its effectiveness on survival in real-world resuscitations remains unknown. ", doi="10.2196/15762", url="https://mhealth.jmir.org/2020/5/e15762", url="http://www.ncbi.nlm.nih.gov/pubmed/32427115" } @Article{info:doi/10.2196/14983, author="Torabi, Asad and Khemka, Abhishek and Bateman, V. Pantila", title="A Cardiology Handbook App to Improve Medical Education for Internal Medicine Residents: Development and Usability Study", journal="JMIR Med Educ", year="2020", month="Apr", day="16", volume="6", number="1", pages="e14983", keywords="mobile learning", keywords="medical reference app", keywords="cardiology", keywords="internal medicine", abstract="Background: At most institutions, internal medicine residents struggle with balancing clinical duties and learning opportunities, particularly during busy cardiology ward rotations. To improve learning experiences for residents, we helped develop a cardiology handbook app to supplement cardiology education. Objective: The aim of this study was to report the development, implementation, and preliminary impact of the Krannert Cardiology Handbook app on graduate medical education. Methods: In June 2017, 122 residents at Indiana University were invited to download the digital handbook in the Krannert app. The Krannert app featured a total of 13 chapters written by cardiology fellows and faculty at Indiana University. Residents were surveyed on their self-reported improvement in cardiology knowledge and level of satisfaction after using the Krannert app. Residents were also surveyed regarding their preference for a digital handbook app versus a paper handbook. Results: Of the 122 residents, 38 trainees (31.1\%) participated in survey evaluations. Among all respondents, 31 app users (82\%) reported that the app helped improve their cardiology knowledge base. The app had an overall favorable response. Conclusions: The Krannert app shows promise in augmenting clinical education in cardiology with mobile learning. Future work includes adding new topics, updating the content, and comparing the app to other learning modalities. ", doi="10.2196/14983", url="http://mededu.jmir.org/2020/1/e14983/", url="http://www.ncbi.nlm.nih.gov/pubmed/32297866" } @Article{info:doi/10.2196/16258, author="Lozano-Lozano, Mario and Galiano-Castillo, Noelia and Fern{\'a}ndez-Lao, Carolina and Postigo-Martin, Paula and {\'A}lvarez-Salvago, Francisco and Arroyo-Morales, Manuel and Cantarero-Villanueva, Irene", title="The Ecofisio Mobile App for Assessment and Diagnosis Using Ultrasound Imaging for Undergraduate Health Science Students: Multicenter Randomized Controlled Trial", journal="J Med Internet Res", year="2020", month="Mar", day="10", volume="22", number="3", pages="e16258", keywords="undergraduate", keywords="OSCE", keywords="mHealth", keywords="teaching and learning strategies", abstract="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 ", doi="10.2196/16258", url="https://www.jmir.org/2020/3/e16258", url="http://www.ncbi.nlm.nih.gov/pubmed/32154784" } @Article{info:doi/10.2196/16987, author="Phungoen, Pariwat and Promto, Songwoot and Chanthawatthanarak, Sivit and Maneepong, Sawitree and Apiratwarakul, Korakot and Kotruchin, Praew and Mitsungnern, Thapanawong", title="Precourse Preparation Using a Serious Smartphone Game on Advanced Life Support Knowledge and Skills: Randomized Controlled Trial", journal="J Med Internet Res", year="2020", month="Mar", day="9", volume="22", number="3", pages="e16987", keywords="CPR training", keywords="gamified learning", keywords="medical education", keywords="serious game learning", abstract="Background: In the past several years, gamified learning has been growing in popularity in various medical educational contexts including cardiopulmonary resuscitation (CPR) training. Furthermore, prior work in Basic Life Support (BLS) training has demonstrated the benefits of serious games as a method for pretraining among medical students. However, there is little evidence to support these benefits with regard to Advanced Life Support (ALS) training. Objective: We compare the effects of a brief precourse ALS preparation using a serious smartphone game on student knowledge, skills, and perceptions in this area with those of conventional ALS training alone. Methods: A serious game (Resus Days) was developed by a Thai physician based on global ALS clinical practice guidelines. Fifth-year medical students were enrolled and randomized to either the game group or the control group. Participants in both groups attended a traditional ALS lecture, but the game group was assigned to play Resus Days for 1 hour before attending the lecture and were allowed to play as much as they wished during the training course. All students underwent conventional ALS training, and their abilities were evaluated using multiple-choice questions and with hands-on practice on a mannequin. Subject attitudes and perceptions about the game were evaluated using a questionnaire. Results: A total of 105 students participated in the study and were randomly assigned to either the game group (n=52) or the control group (n=53). Students in the game group performed better on the ALS algorithm knowledge posttest than those in the control group (17.22 [SD 1.93] vs 16.60 [SD 1.97], P=.01; adjusted mean difference [AMD] 0.93; 95\% CI 0.21-1.66). The game group's pass rate on the skill test was also higher but not to a statistically significant extent (79\% vs 66\%, P=.09; adjusted odds ratio [AOR] 2.22; 95\% CI 0.89-5.51). Students indicated high satisfaction with the game (9.02 [SD 1.11] out of 10). Conclusions: Engaging in game-based preparation prior to an ALS training course resulted in better algorithm knowledge scores for medical students than attending the course alone. Trial Registration: Thai Clinical Trials Registry HE611533; https://tinyurl.com/wmbp3q7 ", doi="10.2196/16987", url="http://www.jmir.org/2020/3/e16987/", url="http://www.ncbi.nlm.nih.gov/pubmed/32149711" } @Article{info:doi/10.2196/15998, author="Tyagi, Hanu and Sabharwal, Manisha and Dixit, Nishi and Pal, Arnab and Deo, Sarang", title="Leveraging Providers' Preferences to Customize Instructional Content in Information and Communications Technology--Based Training Interventions: Retrospective Analysis of a Mobile Phone--Based Intervention in India", journal="JMIR Mhealth Uhealth", year="2020", month="Mar", day="3", volume="8", number="3", pages="e15998", keywords="public health", keywords="mobile health", keywords="health care providers", keywords="health care workers", keywords="instructional technology", keywords="information technology", keywords="infectious diseases", keywords="provider training", keywords="learning preferences", abstract="Background: Many public health programs and interventions across the world increasingly rely on using information and communications technology (ICT) tools to train and sensitize health professionals. However, the effects of such programs on provider knowledge, practice, and patient health outcomes have been inconsistent. One of the reasons for the varied effectiveness of these programs is the low and varying levels of provider engagement, which, in turn, could be because of the form and mode of content used. Tailoring instructional content could improve engagement, but it is expensive and logistically demanding to do so with traditional training Objective: This study aimed to discover preferences among providers on the form (articles or videos), mode (featuring peers or experts), and length (short or long) of the instructional content; to quantify the extent to which differences in these preferences can explain variation in provider engagement with ICT-based training interventions; and to compare the power of content preferences to explain provider engagement against that of demographic variables. Methods: We used data from a mobile phone--based intervention focused on improving tuberculosis diagnostic practices among 24,949 private providers from 5 specialties and 1734 cities over 1 year. Engagement time was used as the primary outcome to assess provider engagement. K-means clustering was used to segment providers based on the proportion of engagement time spent on content formats, modes, and lengths to discover their content preferences. The identified clusters were used to predict engagement time using a linear regression model. Subsequently, we compared the accuracy of the cluster-based prediction model with one based on demographic variables of providers (eg, specialty and geographic location). Results: The average engagement time across all providers was 7.5 min (median 0, IQR 0-1.58). A total of 69.75\% (17,401/24,949) of providers did not consume any content. The average engagement time for providers with nonzero engagement time was 24.8 min (median 4.9, IQR 2.2-10.1). We identified 4 clusters of providers with distinct preferences for form, mode, and length of content. These clusters explained a substantially higher proportion of the variation in engagement time compared with demographic variables (32.9\% vs 1.0\%) and yielded a more accurate prediction for the engagement time (root mean square error: 4.29 vs 5.21 and mean absolute error: 3.30 vs 4.26). Conclusions: Providers participating in a mobile phone--based digital campaign have inherent preferences for instructional content. Targeting providers based on individual content preferences could result in higher provider engagement as compared to targeting providers based on demographic variables. ", doi="10.2196/15998", url="https://mhealth.jmir.org/2020/3/e15998", url="http://www.ncbi.nlm.nih.gov/pubmed/32130191" } @Article{info:doi/10.2196/16403, author="Dittrich, Florian and Back, Alexander David and Harren, Katharina Anna and J{\"a}ger, Marcus and Landgraeber, Stefan and Reinecke, Felix and Beck, Sascha", title="A Possible Mobile Health Solution in Orthopedics and Trauma Surgery: Development Protocol and User Evaluation of the Ankle Joint App", journal="JMIR Mhealth Uhealth", year="2020", month="Feb", day="26", volume="8", number="2", pages="e16403", keywords="smartphone", keywords="ankle sprain", keywords="rehabilitation", keywords="self-care", keywords="mHealth", keywords="mobile phone", abstract="Background: Ankle sprains are one of the most frequent sports injuries. With respect to the high prevalence of ankle ligament injuries and patients' young age, optimizing treatment and rehabilitation is mandatory to prevent future complications such as chronic ankle instability or osteoarthritis. Objective: In modern times, an increasing amount of smartphone usage in patient care is evident. Studies investigating mobile health (mHealth)--based rehabilitation programs after ankle sprains are rare. The aim of this study was to expose any issues present in the development process of a medical app as well as associated risks and chances. Methods: The development process of the Ankle Joint App was defined in chronological order using a protocol. The app's quality was evaluated using the (user) German Mobile App Rating Scale (MARS-G) by voluntary foot and ankle surgeons (n=20) and voluntary athletes (n=20). Results: A multidisciplinary development team built a hybrid app with a corresponding backend structure. The app's content provides actual medical literature, training videos, and a log function. Excellent interrater reliability (interrater reliability=0.92; 95\% CI 0.86-0.96) was obtained. The mean overall score for the Ankle Joint App was 4.4 (SD 0.5). The mean subjective quality scores were 3.6 (surgeons: SD 0.7) and 3.8 (athletes: SD 0.5). Behavioral change had mean scores of 4.1 (surgeons: SD 0.7) and 4.3 (athletes: SD 0.7). The medical gain value, rated by the surgeons only, was 3.9 (SD 0.6). Conclusions: The data obtained demonstrate that mHealth-based rehabilitation programs might be a useful tool for patient education and collection of personal data. The achieved (user) MARS-G scores support a high quality of the tested app. Medical app development with an a priori defined target group and a precisely intended purpose, in a multidisciplinary team, is highly promising. Follow-up studies are required to obtain funded evidence for the ankle joints app's effects on economical and medical aspects in comparison with established nondigital therapy paths. ", doi="10.2196/16403", url="http://mhealth.jmir.org/2020/2/e16403/", url="http://www.ncbi.nlm.nih.gov/pubmed/32130171" } @Article{info:doi/10.2196/12229, author="Hilty, Donald and Chan, Steven and Torous, John and Luo, John and Boland, Robert", title="A Framework for Competencies for the Use of Mobile Technologies in Psychiatry and Medicine: Scoping Review", journal="JMIR Mhealth Uhealth", year="2020", month="Feb", day="21", volume="8", number="2", pages="e12229", keywords="apps", keywords="behavior", keywords="education", keywords="mobile", keywords="outcome", keywords="competency", keywords="technology", keywords="health", keywords="mobile phone", keywords="framework", abstract="Background: To ensure quality care, clinicians need skills, knowledge, and attitudes related to technology that can be measured. Objective: This paper sought out competencies for mobile technologies and/or an approach to define them. Methods: A scoping review was conducted to answer the following research question, ``What skills are needed for clinicians and trainees to provide quality care via mHealth, have they been published, and how can they be made measurable and reproducible to teach and assess them?'' The review was conducted in accordance with the 6-stage scoping review process starting with a keyword search in PubMed/Medical Literature Analysis and Retrieval System Online, APA PsycNET, Cochrane, EMBASE, PsycINFO, Web of Science, and Scopus. The literature search focused on keywords in 4 concept areas: (1) competencies, (2) mobile technologies, (3) telemedicine mode, and (4) health. Moreover, 2 authors independently, in parallel, screened the search results for potentially relevant studies based on titles and abstracts. The authors reviewed the full-text articles for final inclusion based on inclusion/exclusion criteria. Inclusion criteria were keywords used from concept area 1 (competencies) and 2 (mobile technologies) and either 3 (telemedicine mode) or 4 (health). Exclusion criteria included, but were not limited to, keywords used from a concept area in isolation, discussion of skills abstractly, outline or listing of what clinicians need without detail, and listing immeasurable behaviors. Results: From a total of 1232 results, the authors found 78 papers eligible for a full-text review and found 14 papers directly relevant to the 4 key concepts. Although few studies specifically discussed skills, the majority were clinical studies, and the literature included no lists of measurable behaviors or competency sets for mobile technology. Therefore, a framework for mobile technology competencies was built according to the review, expert consensus, and recommendations of the Institute of Medicine's Health Professions Education Summit and Accreditation Council of Graduate Medical Education framework. This framework borrows from existing competency framework domains in telepsychiatry and social media (patient care, medical knowledge, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal skills and communication) and added domains of mHealth clinical decision support, device/technology assessment/selection, and information flow management across an electronic health record platform. mHealth Asynchronous components require additional traditional learning, teaching, supervisory and evaluation practices. Interactive curricula with case-, problem-, and system-based teaching may help faculty focus on decision making and shape skills and attitudes to complement clinical exposure. Conclusions: Research is needed on how to customize implementation and evaluation of mHealth competencies and to ensure skill development is linked to the quality of care. This will require the management of organizational change with technology and the creation of a positive electronic culture in a complex policy and regulatory environment. ", doi="10.2196/12229", url="http://mhealth.jmir.org/2020/2/e12229/", url="http://www.ncbi.nlm.nih.gov/pubmed/32130153" } @Article{info:doi/10.2196/15828, author="Hughes, Charmayne and Musselman, A. Elaine and Walsh, Lilia and Mariscal, Tatiana and Warner, Sam and Hintze, Amy and Rashidi, Neela and Gordon-Murer, Chloe and Tanha, Tiana and Licudo, Fahrial and Ng, Rachel and Tran, Jenna", title="The mPOWERED Electronic Learning System for Intimate Partner Violence Education: Mixed Methods Usability Study", journal="JMIR Nursing", year="2020", month="Jan", day="3", volume="3", number="1", pages="e15828", keywords="intimate partner violence", keywords="domestic violence", keywords="nursing education", keywords="learning", abstract="Background: Nurse practitioners are a common resource for victims of intimate partner violence (IPV) presenting to health care settings. However, they often have inadequate knowledge about IPV and lack self-efficacy and confidence to be able to screen for IPV and communicate effectively with patients. Objective: The aim of this study was to develop and test the usability of a blended learning system aimed at educating nurse practitioner students on topics related to IPV (ie, the mPOWERED system [Health Equity Institute]). Methods: Development of the mPOWERED system involved usability testing with 7 nurse educators (NEs) and 18 nurse practitioner students. Users were asked to complete usability testing using a speak-aloud procedure and then complete a satisfaction and usability questionnaire. Results: Overall, the mPOWERED system was deemed to have high usability and was positively evaluated by both NEs and nurse practitioner students. Respondents provided critical feedback that will be used to improve the system. Conclusions: By including target end users in the design and evaluation of the mPOWERED system, we have developed a blended IPV learning system that can easily be integrated into health care education. Larger-scale evaluation of the pedagogical impact of this system is underway. ", doi="10.2196/15828", url="https://nursing.jmir.org/2020/1/e15828", url="http://www.ncbi.nlm.nih.gov/pubmed/34345778" } @Article{info:doi/10.2196/15386, author="Yang, Xiaoxian and Xie, Ri-Hua and Chen, Si and Yu, Wei and Liao, Yan and Krewski, Daniel and Wen, Wu Shi", title="Using Video Feedback Through Smartphone Instant Messaging in Fundamental Nursing Skills Teaching: Observational Study", journal="JMIR Mhealth Uhealth", year="2019", month="Sep", day="05", volume="7", number="9", pages="e15386", keywords="video feedback", keywords="smartphone", keywords="mobile phone", keywords="student nurses", keywords="fundamental nursing skill", keywords="teaching", abstract="Background: Video feedback has been shown to be an effective teaching tool that can improve student learning when having them view their own performance. However, the literature on the effect of integrating smartphones with video feedback in fundamental nursing skills teaching is sparse. Objective: This study aimed to explore the potential effects of video feedback through smartphone-based instant messaging on teaching undergraduate nursing students fundamental nursing skills. Methods: We conducted a study on teaching fundamental nursing skills to 6 classes of second-year undergraduate nursing students. In 2 classes (the intervention group), the instructor elected to use smartphone-based video feedback to facilitate teaching; instructors in the other 4 classes (the control group) elected to use routine methods of teaching without video feedback. Scores from the final examination, in-class assignments, and the General Self-Efficacy Scale questionnaire were collected and compared between the two groups. Multiple linear regression analysis was performed to estimate the independent effect of video feedback after adjusting for gender, age, and prior experience in the use of WeChat/QQ in learning applications. An ad hoc questionnaire was used for student evaluation of the novel smartphone-based video feedback teaching method. Results: A total of 195 nursing students (65 in the video feedback group and 130 in the control group) completed the study and were included in the final analysis. Mean and standard deviation of scores on the final examination, bed making, aseptic procedure, vital signs measurement, and oxygen therapy were 91.29 (SD 2.36), 90.52 (SD 3.18), 93.23 (SD 3.16), 91.65 (SD 4.21), and 92.06 (SD 3.58), respectively, in the video feedback group and 89.99 (SD 3.12), 81.71 (SD 8.63), 87.12 (SD 5.50), 87.45 (SD 8.00), and 90.37 (SD 6.36), respectively, in the control group (differences were statistically significant). The mean and standard deviation of scores for assignments in catheterization and enema and General Self-Efficacy Scale were 89.69 (SD 3.22), 91.14 (SD 3.15), and 24.52 (SD 5.35), respectively, in the video feedback group and 88.82 (SD 7.48), 90.79 (SD 6.08), and 24.50 (SD 6.16), respectively, in the control group (differences were not statistically significant). The majority (over 98\%) of nursing students were satisfied with this smartphone-based video feedback teaching method. Conclusions: Video feedback through smartphone-based instant messaging may be an effective way to improve nursing students' academic performance and professional skills. ", doi="10.2196/15386", url="https://mhealth.jmir.org/2019/9/e15386", url="http://www.ncbi.nlm.nih.gov/pubmed/31489839" } @Article{info:doi/10.2196/12809, author="Zupanic, Michaela and Rebacz, Patrick and Ehlers, P. Jan", title="Media Use Among Students From Different Health Curricula: Survey Study", journal="JMIR Med Educ", year="2019", month="Aug", day="19", volume="5", number="2", pages="e12809", keywords="social media", keywords="medical education", keywords="computers", keywords="interprofessional relations", keywords="distance education", keywords="health occupations", abstract="Background: Mobile devices such as smartphones, tablets, and laptop computers enable users to search for information and communicate with others at any place and any time. Such devices are increasingly being used at universities for teaching and learning. The use of mobile devices by students depends, among others, on the individual media literacy level and the curricular framework. Objective: The objective of this study was to explore whether there were differences in media use in students from various curricula at the Faculty of Health, Witten/Herdecke University. Methods: During the 2015-16 winter term, a survey was conducted at the Faculty of Health, Witten/Herdecke University, in which a total of 705 students (out of 1091 students; response rate: 705/1091, 64.61\%) from 4 schools participated voluntarily: medicine (346/598), dentistry (171/204), psychology (142/243), and nursing science (46/46). The questionnaire developed for the study included 132 questions on 4 topics: (1) electronic and mobile devices (19 questions), (2) communication and organization of learning (45 questions), (3) apps/programs/websites/media (34 questions), and (4) media literacy (34 questions). The questionnaire was distributed and anonymously completed during in-class courses. Results: Students from all 4 schools had at least two electronic devices, with smartphones (97.4\%, 687/705) and laptops (94.8\%, 669/705) being the most common ones. Students agreed that electronic devices enabled them to effectively structure the learning process (mean 3.16, SD 0.62) and shared the opinion that university teaching should include imparting media literacy (mean 2.84, SD 0.84). Electronic device ownership was the highest among medical students (mean 2.68, SD 0.86) and medical students were the only ones to use a tutorial (36.1\%, 125/346). Dental students most widely used text messages (mean 3.41, SD 0.49) and social media (mean 2.57, SD 1.10) to organize learning. Psychology students considered mobile devices to be most ineffective (mean 2.81, SD 0.83). Nursing science students used emails (mean 3.47, SD 0.73) and desktop computers (39\%, 18/46) most widely. Conclusions: The results show that almost all students use electronic learning (e-learning) tools. At the same time, different profiles for different degree programs become apparent, which are to be attributed to not only the varying curricula and courses but also to the life circumstances of different age groups. Universities should, therefore, pay attention to the diverse user patterns and media literacy levels of students when planning courses to enable successful use of e-learning methods. ", doi="10.2196/12809", url="http://mededu.jmir.org/2019/2/e12809/", url="http://www.ncbi.nlm.nih.gov/pubmed/31429412" } @Article{info:doi/10.2196/13442, author="Aksoy, Emin", title="Comparing the Effects on Learning Outcomes of Tablet-Based and Virtual Reality--Based Serious Gaming Modules for Basic Life Support Training: Randomized Trial", journal="JMIR Serious Games", year="2019", month="May", day="01", volume="7", number="2", pages="e13442", keywords="serious gaming", keywords="virtual reality", keywords="health care education", abstract="Background: Serious gaming is recognized as a training tool due its potential for a risk-free educational environment. There is still limited research about using serious gaming modules for emergency skills training. Objective: The aim of this study is to compare the effects on the knowledge level of participants after using a tablet-based serious game and a virtual reality (VR)--based serious game for Basic Life Support using a pretest/posttest method. Methods: The study was designed as a randomized trial comparing pretest and posttest results. A tablet-based and VR-based serious game with identical content was used for 40 participants. Over half of them (22/40, 55\%) were included in the VR group and just under half (18/40, 45\%) were in the tablet group. Student t test and Wilcoxon signed rank tests were used to determine the relation between the dependent and independent variables. In order to determine the effect size of the results, the effect size calculator (Cohen d) for t test was used. There is a significant difference between pre- and posttest results in both groups (P=.001; Wilcoxon). Results: Mean posttest results were significantly higher in both groups. The posttest results were significantly higher in the VR group in terms of pre- and posttest changes (P=.021; Student t test). Conclusions: Past research studies have shown that serious gaming presents a favorable additional tool for medical education. The results indicate that both serious gaming modules are effective and that VR-based serious gaming is more efficient in terms of learning outcome than tablet-based gaming. ", doi="10.2196/13442", url="http://games.jmir.org/2019/2/e13442/", url="http://www.ncbi.nlm.nih.gov/pubmed/31042153" } @Article{info:doi/10.2196/12713, author="Ebner, Florian and De Gregorio, Amelie and Schochter, Fabienne and Bekes, Inga and Janni, Wolfgang and Lato, Krisztian", title="Effect of an Augmented Reality Ultrasound Trainer App on the Motor Skills Needed for a Kidney Ultrasound: Prospective Trial", journal="JMIR Serious Games", year="2019", month="May", day="01", volume="7", number="2", pages="e12713", keywords="ultrasound trainer", keywords="mobile device", keywords="mobile apps", keywords="augmented reality", keywords="kidney", keywords="sensitivity and specificity", keywords="ultrasonography", keywords="education", keywords="simulation training", keywords="telemedicine", abstract="Background: Medical education is evolving from ``learning by doing'' to simulation-based hands-on tutorials. Objective: The aim of this prospective 2-armed study was to evaluate a newly developed augmented reality ultrasound app and its effect on educational training and diagnostic accuracy. Methods: We recruited 66 medical students and, using imaging and measuring a kidney as quality indicators, tested them on the time they needed for these tasks. Both groups used textbooks as preparation; in addition, the study group had access to a virtual ultrasound simulation app for mobile devices. Results: There was no significant difference between the study arms regarding age (P=.97), sex (P=.14), and previous ultrasound experience (P=.66). The time needed to complete the kidney measurements also did not differ significantly (P=.26). However, the results of the longitudinal kidney measurements differed significantly between the study and control groups, with larger, more realistic values in the study group (right kidney: study group median 105.3 mm, range 86.1-127.1 mm, control group median 92 mm, range 50.4-112.2 mm; P<.001; left kidney: study group median 100.3 mm, range 81.7-118.6 mm, control group median 85.3 mm, range 48.3-113.4 mm; P<.001). Furthermore, whereas all students of the study group obtained valid measurements, students of the control group did not obtain valid measurements of 1 or both kidneys in 7 cases. Conclusions: The newly developed augmented reality ultrasound simulator mobile app provides a useful add-on for ultrasound education and training. Our results indicate that medical students' use of the mobile app for training purposes improved the quality of kidney measurements. ", doi="10.2196/12713", url="http://games.jmir.org/2019/2/e12713/", url="http://www.ncbi.nlm.nih.gov/pubmed/31042155" } @Article{info:doi/10.2196/12825, author="Clavier, Thomas and Ramen, Julie and Dureuil, Bertrand and Veber, Benoit and Hanouz, Jean-Luc and Dupont, Herv{\'e} and Lebuffe, Gilles and Besnier, Emmanuel and Compere, Vincent", title="Use of the Smartphone App WhatsApp as an E-Learning Method for Medical Residents: Multicenter Controlled Randomized Trial", journal="JMIR Mhealth Uhealth", year="2019", month="Apr", day="09", volume="7", number="4", pages="e12825", keywords="education, medical, graduate/methods", keywords="educational measurement", keywords="anesthesiology", keywords="internship and residency", keywords="trauma", keywords="hemorrhage", keywords="mobile applications", keywords="WhatsApp", keywords="smartphone", keywords="teaching materials", keywords="mobile phone", abstract="Background: The WhatsApp smartphone app is the most widely used instant messaging app in the world. Recent studies reported the use of WhatsApp for educational purposes, but there is no prospective study comparing WhatsApp's pedagogical effectiveness to that of any other teaching modality. Objective: The main objective of this study was to measure the impact of a learning program via WhatsApp on clinical reasoning in medical residents. Methods: This prospective, randomized, multicenter study was conducted among first- and second-year anesthesiology residents (offline recruitment) from four university hospitals in France. Residents were randomized in two groups of online teaching (WhatsApp and control). The WhatsApp group benefited from daily delivery of teaching documents on the WhatsApp app and a weekly clinical case supervised by a senior physician. In the control group, residents had access to the same documents via a traditional computer electronic learning (e-learning) platform. Medical reasoning was self-assessed online by a script concordance test (SCT; primary parameter), and medical knowledge was assessed using multiple-choice questions (MCQs). The residents also completed an online satisfaction questionnaire. Results: In this study, 62 residents were randomized (32 to the WhatsApp group and 30 to the control group) and 22 residents in each group answered the online final evaluation. We found a difference between the WhatsApp and control groups for SCTs (60\% [SD 9\%] vs 68\% [SD 11\%]; P=.006) but no difference for MCQs (18/30 [SD 4] vs 16/30 [SD 4]; P=.22). Concerning satisfaction, there was a better global satisfaction rate in the WhatsApp group than in the control group (8/10 [interquartile range 8-9] vs 8/10 [interquartile range 8-8]; P=.049). Conclusions: Compared to traditional e-learning, the use of WhatsApp for teaching residents was associated with worse clinical reasoning despite better global appreciation. The use of WhatsApp probably contributes to the dispersion of attention linked to the use of the smartphone. The impact of smartphones on clinical reasoning should be studied further. ", doi="10.2196/12825", url="http://mhealth.jmir.org/2019/4/e12825/", url="http://www.ncbi.nlm.nih.gov/pubmed/30964435" } @Article{info:doi/10.2196/12945, author="Tudor Car, Lorainne and Kyaw, Myint Bhone and Dunleavy, Gerard and Smart, A. Neil and Semwal, Monika and Rotgans, I. Jerome and Low-Beer, Naomi and Campbell, James", title="Digital Problem-Based Learning in Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration", journal="J Med Internet Res", year="2019", month="Feb", day="28", volume="21", number="2", pages="e12945", keywords="randomized controlled trials", keywords="effectiveness", keywords="systematic review", keywords="problem-based learning", keywords="medical education", abstract="Background: The use of digital education in problem-based learning, or digital problem-based learning (DPBL), is increasingly employed in health professions education. DPBL includes purely digitally delivered as well as blended problem-based learning, wherein digital and face-to-face learning are combined. Objective: The aim of this review is to evaluate the effectiveness of DPBL in improving health professionals' knowledge, skills, attitudes, and satisfaction. Methods: We used the gold-standard Cochrane methods to conduct a systematic review of randomized controlled trials (RCTs). We included studies that compared the effectiveness of DPBL with traditional learning methods or other forms of digital education in improving health professionals' knowledge, skills, attitudes, and satisfaction. Two authors independently screened studies, extracted data, and assessed the risk of bias. We contacted study authors for additional information, if necessary. We used the random-effects model in the meta-analyses. Results: Nine RCTs involving 890 preregistration health professionals were included. Digital technology was mostly employed for presentation of problems. In three studies, PBL was delivered fully online. Digital technology modalities spanned online learning, offline learning, virtual reality, and virtual patients. The control groups consisted of traditional PBL and traditional learning. The pooled analysis of seven studies comparing the effect of DPBL and traditional PBL reported little or no difference in postintervention knowledge outcomes (standardized mean difference [SMD] 0.19, 95\% CI 0.00-0.38). The pooled analysis of three studies comparing the effect of DPBL to traditional learning on postintervention knowledge outcomes favored DPBL (SMD 0.67, 95\% CI 0.14-1.19). For skill development, the pooled analysis of two studies comparing DPBL to traditional PBL favored DPBL (SMD 0.30, 95\% CI 0.07-0.54). Findings on attitudes and satisfaction outcomes were mixed. The included studies mostly had an unclear risk of bias. Conclusions: Our findings suggest that DPBL is as effective as traditional PBL and more effective than traditional learning in improving knowledge. DPBL may be more effective than traditional learning or traditional PBL in improving skills. Further studies should evaluate the use of digital technology for the delivery of other PBL components as well as PBL overall. ", doi="10.2196/12945", url="https://www.jmir.org/2019/2/e12945/", url="http://www.ncbi.nlm.nih.gov/pubmed/30816846" } @Article{info:doi/10.2196/12895, author="Lall, Priya and Rees, Rebecca and Law, Yi Gloria Chun and Dunleavy, Gerard and Coti{\v c}, ?iva and Car, Josip", title="Influences on the Implementation of Mobile Learning for Medical and Nursing Education: Qualitative Systematic Review by the Digital Health Education Collaboration", journal="J Med Internet Res", year="2019", month="Feb", day="28", volume="21", number="2", pages="e12895", keywords="medical education", keywords="nursing education", keywords="distance education", keywords="qualitative research", keywords="systematic review", abstract="Background: In the past 5 decades, digital education has increasingly been used in health professional education. Mobile learning (mLearning), an emerging form of educational technology using mobile devices, has been used to supplement learning outcomes through enabling conversations, sharing information and knowledge with other learners, and aiding support from peers and instructors regardless of geographic distance. Objective: This review aimed to synthesize findings from qualitative or mixed-methods studies to provide insight into factors facilitating or hindering implementation of mLearning strategies for medical and nursing education. Methods: A systematic search was conducted across a range of databases. Studies with the following criteria were selected: examined mLearning in medical and nursing education, employed a mixed-methods or qualitative approach, and published in English after 1994. Findings were synthesized using a framework approach. Results: A total of 1946 citations were screened, resulting in 47 studies being selected for inclusion. Most studies evaluated pilot mLearning interventions. The synthesis identified views on valued aspects of mobile devices in terms of efficiency and personalization but concerns over vigilance and poor device functionality; emphasis on the social aspects of technology, especially in a clinical setting; the value of interaction learning for clinical practice; mLearning as a process, including learning how to use a device; and the importance of institutional infrastructure and policies. Conclusions: The portability of mobile devices can enable interactions between learners and educational material, fellow learners, and educators in the health professions. However, devices need to be incorporated institutionally, and learners and educators need additional support to fully comprehend device or app functions. The strategic support of mLearning is likely to require procedural guidance for practice settings and device training and maintenance services on campus. ", doi="10.2196/12895", url="https://www.jmir.org/2019/2/e12895/", url="http://www.ncbi.nlm.nih.gov/pubmed/30816847" } @Article{info:doi/10.2196/12128, author="Adam, Maya and McMahon, A. Shannon and Prober, Charles and B{\"a}rnighausen, Till", title="Human-Centered Design of Video-Based Health Education: An Iterative, Collaborative, Community-Based Approach", journal="J Med Internet Res", year="2019", month="Jan", day="30", volume="21", number="1", pages="e12128", keywords="human-centered design", keywords="health promotion", keywords="health behavior", keywords="health knowledge, attitudes, practice", keywords="community health workers", keywords="telemedicine", keywords="eHealth", keywords="mHealth", doi="10.2196/12128", url="http://www.jmir.org/2019/1/e12128/", url="http://www.ncbi.nlm.nih.gov/pubmed/30698531" } @Article{info:doi/10.2196/12637, author="Barteit, Sandra and Neuhann, Florian and B{\"a}rnighausen, Till and Bowa, Annel and L{\"u}ders, Sigrid and Malunga, Gregory and Chileshe, Geoffrey and Marimo, Clemence and Jahn, Albrecht", title="Perspectives of Nonphysician Clinical Students and Medical Lecturers on Tablet-Based Health Care Practice Support for Medical Education in Zambia, Africa: Qualitative Study", journal="JMIR Mhealth Uhealth", year="2019", month="Jan", day="15", volume="7", number="1", pages="e12637", keywords="educational technology", keywords="computers, handheld", keywords="computer-assisted decision making", keywords="mobile apps", keywords="information dissemination", keywords="education", keywords="allied health occupations", keywords="Africa, Southern", keywords="Zambia", abstract="Background: Zambia is faced with a severe shortage of health workers and challenges in national health financing. This burdens the medical licentiate practitioner (MLP) program for training nonphysician clinical students in Zambia because of the shortage of qualified medical lecturers and learning resources at training sites. To address this shortage and strengthen the MLP program, a self-directed electronic health (eHealth) platform was introduced, comprising technology-supported learning (e-learning) for medical education and support for health care practice. MLP students were provided with tablets that were preloaded with content for offline access. Objective: This study aimed to explore MLP students' and medical lecturers' perceptions of the self-directed eHealth platform with an offline-based tablet as a training and health care practice support tool during the first year of full implementation. Methods: We conducted in-depth qualitative interviews with 8 MLP students and 5 lecturers and 2 focus group discussions with 16 students to gain insights on perceptions of the usefulness, ease of use, and adequacy of self-directed e-learning and health care practice support accessible through the offline-based tablet. Participants were purposively sampled. Verbatim transcripts were analyzed following hypothesis coding. Results: The eHealth platform (e-platform), comprising e-learning for medical education and health care practice support, was positively received by students and medical lecturers and was seen as a step toward modernizing the MLP program. Tablets enabled equal access to offline learning contents, thus bridging the gap of slow or no internet connections. The study results indicated that the e-platform appears adequate to strengthen medical education within this low-resource setting. However, student self-reported usage was low, and medical lecturer usage was even lower. One stated reason was the lack of training in tablet usage and another was the quality of the tablets. The mediocre quality and quantity of most e-learning contents were perceived as a primary concern as materials were reported to be outdated, missing multimedia features, and addressing only part of the curriculum. Medical lecturers were noted to have little commitment to updating or creating new learning materials. Suggestions for improving the e-platform were given. Conclusions: To address identified major challenges, we plan to (1) introduce half-day training sessions at the beginning of each study year to better prepare users for tablet usage, (2) further update and expand e-learning content by fostering collaborations with MLP program stakeholders and nominating an e-platform coordinator, (3) set up an e-platform steering committee including medical lecturers, (4) incorporate e-learning and e-based health care practice support across the curriculum, as well as (5) implement processes to promote user-generated content. With these measures, we aim to sustainably strengthen the MLP program by implementing the tablet-based e-platform as a serious learning technology for medical education and health care practice support. ", doi="10.2196/12637", url="http://mhealth.jmir.org/2019/1/e12637/" } @Article{info:doi/10.2196/10363, author="Burstein, Brett and Bretholz, Adam", title="A Novel Smartphone App to Support Learning and Maintaining Competency With Bier Blocks for Pediatric Forearm Fracture Reductions: Protocol for a Mixed-Methods Study", journal="JMIR Res Protoc", year="2018", month="Dec", day="21", volume="7", number="12", pages="e10363", keywords="intravenous regional anesthesia", keywords="lidocaine", keywords="procedural sedation", keywords="mobile phone", abstract="Background: Distal forearm fractures are among the most common injuries presenting to the pediatric emergency department (PED). Bier block (BB), or intravenous regional anesthesia, is a safe and effective alternative to procedural sedation for closed reduction of forearm fractures; it is associated with fewer adverse events, a shorter length of stay, and reduced costs. BB has long remained relatively underutilized; however, with an increasing emphasis on efficient resource use and patient-centered care, there is renewed interest in this technique. Objective: Our tertiary PED recently became the first in Canada to successfully implement an active BB program. Subsequently, we developed a mobile BB smartphone app designed to support the sustained departmental use of BB. The app can be used for training and maintenance of competency and incorporates instructional material, as well as our institutional BB protocol, printable medication order sheets, and monitoring forms. The present report describes the development and functionality of the BB smartphone app. Methods: We have described app development and content. App dissemination metrics will be tracked, and user feedback will be analyzed using a self-administered electronic survey. Additionally, app utilization in our PED will be compared with real-world clinical use of BB for fracture reductions. Results: The first iteration of the BB app was launched in 2015, with the most recent update in September 2018. App metric tracking is planned for January 2020 until December 2021. Conclusions: We have highlighted how the BB app serves as a paradigm of an educational tool designed not only for individual users but also for supporting the department-wide implementation and dissemination of a new technique. App dissemination and use metrics will be tracked and correlated with clinical use of BB in the PED. International Registered Report Identifier (IRRID): PRR1-10.2196/10363 ", doi="10.2196/10363", url="http://www.researchprotocols.org/2018/12/e10363/", url="http://www.ncbi.nlm.nih.gov/pubmed/30578214" } @Article{info:doi/10.2196/11061, author="Fern{\'a}ndez-Ayuso, David and Fern{\'a}ndez-Ayuso, Rosa and Del-Campo-Cazallas, Cristino and P{\'e}rez-Olmo, Luis Jos{\'e} and Mat{\'i}as-Pompa, Borja and Fern{\'a}ndez-Carnero, Josu{\'e} and Calvo-Lobo, Cesar", title="The Modification of Vital Signs According to Nursing Students' Experiences Undergoing Cardiopulmonary Resuscitation Training via High-Fidelity Simulation: Quasi-Experimental Study", journal="JMIR Serious Games", year="2018", month="Aug", day="15", volume="6", number="3", pages="e11061", keywords="high-fidelity simulation training", keywords="nursing students", keywords="vital signs", keywords="stress", keywords="anxiety.", abstract="Background: High-fidelity simulation represents a primary tool in nursing education, especially when hands-on practical training is involved. Objective: We sought to determine the influence of high-fidelity clinical simulation, applied during cardiopulmonary resuscitation (CPR) training, on blood pressure, heart rate, stress, and anxiety levels in 2 groups of nursing students. One group had experience in health contexts, whereas the other group had none. Methods: We performed a quasi-experimental study. Data were collected between May and June 2015 and included measurements of all the resting values, before and after participation in CPR clinical simulations regarding the 2 groups of university students (ie, with and without experience). Results: An increase in vital signs was observed in students after participating in a clinical simulation scenario, especially the heart rate. In all students, increased stress and anxiety levels were observed before the first simulation case scenario. Also, in all study groups, a decrease in vital signs, stress levels, and anxiety was observed throughout the study. Conclusions: Participation in high-fidelity simulation experiences has both physiological and psychological effects on students. ", doi="10.2196/11061", url="http://games.jmir.org/2018/3/e11061/", url="http://www.ncbi.nlm.nih.gov/pubmed/30111529" } @Article{info:doi/10.2196/jmir.9956, author="Haubruck, Patrick and Nickel, Felix and Ober, Julian and Walker, Tilman and Bergdolt, Christian and Friedrich, Mirco and M{\"u}ller-Stich, Peter Beat and Forchheim, Franziska and Fischer, Christian and Schmidmaier, Gerhard and Tanner, C. Michael", title="Evaluation of App-Based Serious Gaming as a Training Method in Teaching Chest Tube Insertion to Medical Students: Randomized Controlled Trial", journal="J Med Internet Res", year="2018", month="May", day="21", volume="20", number="5", pages="e195", keywords="games, experimental", keywords="education, professional", keywords="general surgery", keywords="emergency medicine", keywords="problem-based learning", keywords="chest tubes", keywords="simulation training", keywords="clinical competence", abstract="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) ", doi="10.2196/jmir.9956", url="http://www.jmir.org/2018/5/e195/", url="http://www.ncbi.nlm.nih.gov/pubmed/29784634" } @Article{info:doi/10.2196/mededu.9635, author="Khan, Zubair and Darr, Umar and Khan, Ali Muhammad and Nawras, Mohamad and Khalil, Basmah and Abdel-Aziz, Yousef and Alastal, Yaseen and Barnett, William and Sodeman, Thomas and Nawras, Ali", title="Improving Internal Medicine Residents' Colorectal Cancer Screening Knowledge Using a Smartphone App: Pilot Study", journal="JMIR Med Educ", year="2018", month="Mar", day="13", volume="4", number="1", pages="e10", keywords="colorectal cancer", keywords="cancer screening", keywords="early detection of cancer", keywords="residents' education", keywords="smartphone", keywords="mobile apps", abstract="Background: Colorectal cancer (CRC) is the third most common type of cancer and the second leading cause of cancer death in the United States. About one in three adults in the United States is not getting the CRC screening as recommended. Internal medicine residents are deficient in CRC screening knowledge. Objective: The objective of our study was to assess the improvement in internal medicine residents' CRC screening knowledge via a pilot approach using a smartphone app. Methods: We designed a questionnaire based on the CRC screening guidelines of the American Cancer Society, American College of Gastroenterology, and US Preventive Services Task Force. We emailed the questionnaire via a SurveyMonkey link to all the residents of an internal medicine department to assess their knowledge of CRC screening guidelines. Then we designed an educational intervention in the form of a smartphone app containing all the knowledge about the CRC screening guidelines. The residents were introduced to the app and asked to download it onto their smartphones. We repeated the survey to test for changes in the residents' knowledge after publication of the smartphone app and compared the responses with the previous survey. We applied the Pearson chi-square test and the Fisher exact test to look for statistical significance. Results: A total of 50 residents completed the first survey and 41 completed the second survey after publication of the app. Areas of CRC screening that showed statistically significant improvement (P<.05) were age at which CRC screening was started in African Americans, preventive tests being ordered first, identification of CRC screening tests, identification of preventive and detection methods, following up positive tests with colonoscopy, follow-up after colonoscopy findings, and CRC surveillance in diseases. Conclusions: In this modern era of smartphones and gadgets, developing a smartphone-based app or educational tool is a novel idea and can help improve residents' knowledge about CRC screening. ", doi="10.2196/mededu.9635", url="http://mededu.jmir.org/2018/1/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/29535080" } @Article{info:doi/10.2196/jmir.8987, author="Lee, Li-Ang and Chao, Yi-Ping and Huang, Chung-Guei and Fang, Ji-Tseng and Wang, Shu-Ling and Chuang, Cheng-Keng and Kang, Chung-Jan and Hsin, Li-Jen and Lin, Wan-Ni and Fang, Tuan-Jen and Li, Hsueh-Yu", title="Cognitive Style and Mobile E-Learning in Emergent Otorhinolaryngology-Head and Neck Surgery Disorders for Millennial Undergraduate Medical Students: Randomized Controlled Trial", journal="J Med Internet Res", year="2018", month="Feb", day="13", volume="20", number="2", pages="e56", keywords="cognitive style", keywords="e-learning", keywords="mobile technology", keywords="randomized controlled trial", abstract="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) ", doi="10.2196/jmir.8987", url="http://www.jmir.org/2018/2/e56/", url="http://www.ncbi.nlm.nih.gov/pubmed/29439943" } @Article{info:doi/10.2196/mededu.6858, author="Kessler, Craig and Peerschke, I. Ellinor and Chitlur, B. Meera and Kulkarni, Roshni and Holot, Natalia and Cooper, L. David", title="The Coags Uncomplicated App: Fulfilling Educational Gaps Around Diagnosis and Laboratory Testing of Coagulation Disorders", journal="JMIR Med Educ", year="2017", month="Apr", day="18", volume="3", number="1", pages="e6", keywords="blood coagulation disorders", keywords="smartphone", keywords="diagnosis", keywords="hematology", keywords="differential diagnosis", abstract="Background: Patients with coagulation disorders may present to a variety of physician specialties; however, accurate and efficient diagnosis can be challenging for physicians not specialized in hematology, due to identified gaps in knowledge around appropriate laboratory assays and interpretation of test results. Coags Uncomplicated was developed to fill this unmet educational need by increasing practical knowledge of coagulation disorders among nonexpert physicians and other health care professionals (HCPs) in a point-of-care (POC) setting. Objective: The aim of this study was to assess patterns of use of the mobile app Coags Uncomplicated, a tool designed to support education regarding accurate and efficient diagnosis of bleeding disorders. Methods: App metrics were obtained by tracking registered user data. Additionally, a survey was distributed to registered users, to assess circumstances and frequency of use. Results: The most common specialties of 7596 registered US users were hematology-oncology (n=1534, 20.19\%), hematology (n=1014, 13.35\%), and emergency medicine (n=1222, 16.09\%); most identified as physicians (n=4082, 53.74\%). Specialties accounting for the greatest numbers of screen views were hematology-oncology (99,390 views), hematology (47,808 views), emergency medicine (23,121 views), and internal medicine (22,586 views). The most common diagnostic endpoints reached were disseminated intravascular coagulation (DIC; 2713 times), liver disease effect (2108 times), and vitamin K deficiency (1584 times). Of 3424 users asked to take the survey, 262 responded (7.65\%); most were physicians in direct clinical care (71\%) and specialized in hematology-oncology (39\%) or emergency medicine (21\%). Most frequent use was reported by hematologists (69\%, ?6 times) and hematologists-oncologists (38\%, ?6 times). Most physicians (89.2\%) reported using the app for patient-case-related education around appropriate use of laboratory tests in diagnostic evaluation. Physicians rated Lab Value Analyzer (mean 4.43) and Lab Test Algorithm (mean 4.46) tools highly on a 5-point ``how helpful'' scale and were likely to recommend the app to colleagues. Conclusions: App use among physicians and other HCPs is consistent with value as a POC educational tool, which may facilitate differential diagnoses and appropriate early consultation with hematologists. ", doi="10.2196/mededu.6858", url="http://mededu.jmir.org/2017/1/e6/", url="http://www.ncbi.nlm.nih.gov/pubmed/28420603" } @Article{info:doi/10.2196/mededu.5336, author="Rusatira, Christophe Jean and Tomaszewski, Brian and Dusabejambo, Vincent and Ndayiragije, Vincent and Gonsalves, Snedden and Sawant, Aishwarya and Mumararungu, Angeline and Gasana, George and Amendezo, Etienne and Haake, Anne and Mutesa, Leon", title="Enabling Access to Medical and Health Education in Rwanda Using Mobile Technology: Needs Assessment for the Development of Mobile Medical Educator Apps", journal="JMIR Med Educ", year="2016", month="Jun", day="01", volume="2", number="1", pages="e7", keywords="mobile medical education", keywords="technology", keywords="user-centered design", abstract="Background: Lack of access to health and medical education resources for doctors in the developing world is a serious global health problem. In Rwanda, with a population of 11 million, there is only one medical school, hence a shortage in well-trained medical staff. The growth of interactive health technologies has played a role in the improvement of health care in developed countries and has offered alternative ways to offer continuous medical education while improving patient's care. However, low and middle-income countries (LMIC) like Rwanda have struggled to implement medical education technologies adapted to local settings in medical practice and continuing education. Developing a user-centered mobile computing approach for medical and health education programs has potential to bring continuous medical education to doctors in rural and urban areas of Rwanda and influence patient care outcomes. Objective: The aim of this study is to determine user requirements, currently available resources, and perspectives for potential medical education technologies in Rwanda. Methods: Information baseline and needs assessments data collection were conducted in all 44 district hospitals (DHs) throughout Rwanda. The research team collected qualitative data through interviews with 16 general practitioners working across Rwanda and 97 self-administered online questionnaires for rural areas. Data were collected and analyzed to address two key questions: (1) what are the currently available tools for the use of mobile-based technology for medical education in Rwanda, and (2) what are user's requirements for the creation of a mobile medical education technology in Rwanda? Results: General practitioners from different hospitals highlighted that none of the available technologies avail local resources such as the Ministry of Health (MOH) clinical treatment guidelines. Considering the number of patients that doctors see in Rwanda, an average of 32 patients per day, there is need for a locally adapted mobile education app that utilizes specific Rwandan medical education resources. Based on our results, we propose a mobile medical education app that could provide many benefits such as rapid decision making with lower error rates, increasing the quality of data management and accessibility, and improving practice efficiency and knowledge. In areas where Internet access is limited, the proposed mobile medical education app would need to run on a mobile device without Internet access. Conclusions: A user-centered design approach was adopted, starting with a needs assessment with representative end users, which provided recommendations for the development of a mobile medical education app specific to Rwanda. Specific app features were identified through the needs assessment and it was evident that there will be future benefits to ongoing incorporation of user-centered design methods to better inform the software development and improve its usability. Results of the user-centered design reported here can inform other medical education technology developments in LMIC to ensure that technologies developed are usable by all stakeholders. ", doi="10.2196/mededu.5336", url="http://mededu.jmir.org/2016/1/e7/", url="http://www.ncbi.nlm.nih.gov/pubmed/27731861" } @Article{info:doi/10.2196/mhealth.4904, author="Jamal, Amr and Temsah, Mohamad-Hani and Khan, A. Samina and Al-Eyadhy, Ayman and Koppel, Cristina and Chiang, F. Michael", title="Mobile Phone Use Among Medical Residents: A Cross-Sectional Multicenter Survey in Saudi Arabia", journal="JMIR Mhealth Uhealth", year="2016", month="May", day="19", volume="4", number="2", pages="e61", keywords="cell phones", keywords="mobile phone", keywords="telemedicine", keywords="medical education", keywords="medical residencies", keywords="educational techniques", keywords="patient care", keywords="communication methods", keywords="WhatsApp", keywords="Saudi Arabia", keywords="point of care technology", abstract="Background: Mobile phones have great potential for medical education, as they allow health care providers and students to access resources efficiently at the precise time at the point-of-care to help in informed decision making. Objective: The objective of the study was to evaluate the prevalence of mobile phone usage among medical residents and to explore their attitudes, perceptions, and the challenges they experience when using mobile phones in academic and clinical practice. Methods: A cross-sectional survey was conducted on all 133 residents in 17 different specialties across two large academic hospitals in Riyadh, Saudi Arabia. The Web-based validated questionnaire measured mobile phone platform preferences, and their uses in general and medical practice. The perception of confidentiality and safety impact of using mobile phones for communication and accessing patient's data was also explored, alongside challenges of use and how residents learn to use their mobile phone. Results: With a response rate of 101/133 (75.9\%) and mean age of 27.8 (SD 3.0) years, we found that 100/101 (99.0\%) of participants were mobile phone users with mean duration of use of 5.12 (SD 2.4) years, and a range from 1 to 12 years. There was no significant difference in use between male and female respondents. A negative linear correlation was found between age and use duration (P=.004). The most common operating system used by participants was the iOS platform (55/101, 54.5\%), with English the most commonly used language to operate residents' mobile phones (96/100, 96.0\%) despite their native language being Arabic. For communication outside medical practice, chatting applications such as WhatsApp matched phone calls as most commonly used tools (each 88/101, 87.1\%). These were also the primary tools for medical communication, but used at a lower rate (each 65/101, 64.4\%). In medical practice, drug (83/101, 82.2\%) and medical (80/101, 79.2\%) references and medical calculation applications (61/101, 60.4\%) were the most commonly used. Short battery life (48/92, 52\%) was the most common technical difficulty, and distraction at least on a weekly basis (54/92, 58\%) was the most likely side effect of using a mobile phone in medical practice. Practically, all participants agreed with the idea of integrating medical staff mobile phones with the hospital information system. Most residents described themselves as self-learners, while half learned from peers, and a quarter learned from the Internet. Only 7/101 (6.9\%) had received formal training on the medical use of mobile phones. Over half of residents thought it was safe to discuss patients over their personal, nonencrypted email. Conclusions: Mobile phone use among medical residents has become almost universal in academic and clinical settings. Thus, academic and health care institutions should support proper utilization of these devices in medical training and point-of-care decision making, while continuing to protect patient confidentiality. ", doi="10.2196/mhealth.4904", url="http://mhealth.jmir.org/2016/2/e61/", url="http://www.ncbi.nlm.nih.gov/pubmed/27197618" } @Article{info:doi/10.2196/mhealth.4843, author="Rodis, Jennifer and Aungst, Dy Timothy and Brown, V. Nicole and Cui, Yan and Tam, Leonard", title="Enhancing Pharmacy Student Learning and Perceptions of Medical Apps", journal="JMIR mHealth uHealth", year="2016", month="May", day="12", volume="4", number="2", pages="e55", keywords="mobile applications", keywords="pharmacy", keywords="students", keywords="health care", abstract="Background: The use of mobile apps in health care is growing. Current and future practitioners must be equipped with the skills to navigate and utilize apps in patient care, yet few strategies exist for training health care professional students on the usage of apps. Objective: To characterize first-year pharmacy student use of medical apps, evaluate first-year pharmacy student's perception of skills in finding, evaluating, and using medical apps before and after a focused learning experience, and assess student satisfaction and areas for improvement regarding the learning experience. Methods: Students listened to a recorded, Web-based lecture on finding, evaluating, and using mobile apps in patient care. A 2-hour, interactive workshop was conducted during which students were led by an instructor through a discussion on strategies for finding and using apps in health care. The students practiced evaluating 6 different health care--related apps. Surveys were conducted before and after the focused learning experience to assess students' perceptions of medical apps and current use and perspectives on satisfaction with the learning experience and role of technology in health care. Results: This educational intervention is the first described formal, interactive method to educate student pharmacists on medical apps. With a 99\% response rate, surveys conducted before and after the learning experience displayed perceived improvement in student skills related to finding (52/119, 44\% before vs 114/120, 95\% after), evaluating (18/119, 15\% before vs 112/120, 93\% after), and using medical apps in patient care (31/119, 26\% before vs 108/120, 90\% after) and the health sciences classroom (38/119, 32\% before vs 104/120, 87\% after). Students described satisfaction with the educational experience and agreed that it should be repeated in subsequent years (89/120, 74\% agreed or strongly agreed). Most students surveyed possessed portable electronic devices (107/119, 90\% mobile phone) and agreed with the concept of medical apps being an important part of the health care profession in the future (112/119, 94\% before and 115/120, 96\% after). Conclusions: Student pharmacists recognize the key role technology plays in the future of health care. A medical apps workshop was successful in improving student pharmacists' perceptions of ability to find, evaluate, and use medical apps. ", doi="10.2196/mhealth.4843", url="http://mhealth.jmir.org/2016/2/e55/", url="http://www.ncbi.nlm.nih.gov/pubmed/27174684" } @Article{info:doi/10.2196/mededu.4443, author="Zhu, Egui and Lilienthal, Anneliese and Shluzas, Aquino Lauren and Masiello, Italo and Zary, Nabil", title="Design of Mobile Augmented Reality in Health Care Education: A Theory-Driven Framework", journal="JMIR Medical Education", year="2015", month="Sep", day="18", volume="1", number="2", pages="e10", keywords="augmented reality", keywords="health care education", keywords="antibiotics", keywords="general practitioners", keywords="learning environment", keywords="learning theory", keywords="mobile technology", abstract="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. ", doi="10.2196/mededu.4443", url="http://mededu.jmir.org/2015/2/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/27731839" } @Article{info:doi/10.2196/jmir.2497, author="Albrecht, Urs-Vito and Folta-Schoofs, Kristian and Behrends, Marianne and von Jan, Ute", title="Effects of Mobile Augmented Reality Learning Compared to Textbook Learning on Medical Students: Randomized Controlled Pilot Study", journal="J Med Internet Res", year="2013", month="Aug", day="20", volume="15", number="8", pages="e182", keywords="problem-based learning", keywords="cellular phone", keywords="education", keywords="medical", keywords="emotions", abstract="Background: By adding new levels of experience, mobile Augmented Reality (mAR) can significantly increase the attractiveness of mobile learning applications in medical education. Objective: To compare the impact of the heightened realism of a self-developed mAR blended learning environment (mARble) on learners to textbook material, especially for ethically sensitive subjects such as forensic medicine, while taking into account basic psychological aspects (usability and higher level of emotional involvement) as well as learning outcomes (increased learning efficiency). Methods: A prestudy was conducted based on a convenience sample of 10 third-year medical students. The initial emotional status was captured using the ``Profile of Mood States'' questionnaire (POMS, German variation); previous knowledge about forensic medicine was determined using a 10-item single-choice (SC) test. During the 30-minute learning period, the students were randomized into two groups: the first group consisted of pairs of students, each equipped with one iPhone with a preinstalled copy of mARble, while the second group was provided with textbook material. Subsequently, both groups were asked to once again complete the POMS questionnaire and SC test to measure changes in emotional state and knowledge gain. Usability as well as pragmatic and hedonic qualities of the learning material was captured using AttrakDiff2 questionnaires. Data evaluation was conducted anonymously. Descriptive statistics for the score in total and the subgroups were calculated before and after the intervention. The scores of both groups were tested against each other using paired and unpaired signed-rank tests. An item analysis was performed for the SC test to objectify difficulty and selectivity. Results: Statistically significant, the mARble group (6/10) showed greater knowledge gain than the control group (4/10) (Wilcoxon z=2.232, P=.03). The item analysis of the SC test showed a difficulty of P=0.768 (s=0.09) and a selectivity of RPB=0.2. For mARble, fatigue (z=2.214, P=.03) and numbness (z=2.07, P=.04) decreased with statistical significance when comparing pre- and post-tests. Vigor rose slightly, while irritability did not increase significantly. Changes in the control group were insignificant. Regarding hedonic quality (identification, stimulation, attractiveness), there were significant differences between mARble (mean 1.179, CI ?0.440 to 0.440) and the book chapter (mean ?0.982, CI ?0.959 to 0.959); the pragmatic quality mean only differed slightly. Conclusions: The mARble group performed considerably better regarding learning efficiency; there are hints for activating components of the mAR concept that may serve to fascinate the participants and possibly boost interest in the topic for the remainder of the class. While the small sample size reduces our study's conclusiveness, its design seems appropriate for determining the effects of interactive eLearning material with respect to emotions, learning efficiency, and hedonic and pragmatic qualities using a larger group. Trial Registration: German Clinical Trial Register (DRKS), DRKS-ID: DRKS00004685; https://drks-neu.uniklinik-freiburg.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00004685. ", doi="10.2196/jmir.2497", url="http://www.jmir.org/2013/8/e182/", url="http://www.ncbi.nlm.nih.gov/pubmed/23963306" }