Time and learning efficiency in Internet-based learning: a systematic review and meta-analysis

An Approach to the Design and Development of an Accredited Continuing Professional Development e-Learning Module on Virtual Care

Unlabelled

Virtual care appointments expanded rapidly during COVID-19 out of necessity and to enable access and continuity of care for many patients. While previous work has explored health care providers' experiences with telehealth usage on small-scale projects, the broad-level adoption of virtual care during the pandemic has expounded opportunities for a better understanding of how to enhance the integration of telehealth as a regular mode of health care services delivery. Training and education for health care providers on the effective use of virtual care technologies are factors that can help facilitate improved adoption and use. We describe our approach to designing and developing an accredited continuing professional development (CPD) program using e-learning technologies to foster better knowledge and comfort among health care providers with the use of virtual care technologies. First, we discuss our approach to undertaking a systematic needs assessment study using a survey questionnaire of providers, key informant interviews, and a patient focus group. Next, we describe our steps in consulting with key stakeholder groups in the health system and arranging committees to inform the design of the program and address accreditation requirements. The instructional design features and aspects of the e-learning module are then described in depth, and our plan for evaluating the program is shared as well. As a CPD modality, e-learning offers the opportunity to enhance access to timely continuing professional education for health care providers who may be geographically dispersed across rural and remote communities.

The CKD-DETECT V2.0 study: A randomised controlled trial evaluating the effectiveness of an infographic poster compared with an e-learning program on general practice nurses' knowledge and learning efficiency about chronic kidney disease risk factors and best practice screening procedures

AIMS AND OBJECTIVES

To evaluate: (a) the effectiveness of an infographic poster compared with an e-learning program on general practice nurses' knowledge about chronic kidney disease risk factors and best practice screening procedures and (b) the effectiveness of an infographic poster compared with an e-learning program on general practice nurses' learning time and learning efficiency.

BACKGROUND

The screening and early detection of chronic kidney disease is essential in reducing its burden on the health system and those affected by it. General practice nurses are well-positioned to assist in its early detection.

DESIGN

Parallel-group, single-blinded, pre-post interventional randomised control design.

METHOD

This study was reported in accordance with the Consolidated Standards of Reporting Trials (CONSORT). Participants were registered or enrolled nurses working in general practice settings across Australia. The intervention group (n = 173) received an infographic poster about chronic kidney disease risk factors and best practice screening procedures, whereas the control group (n = 170) received an interactive e-learning program. Data were collected using an 8-item pre-post knowledge evaluation instrument. Time spent learning were collected through a self-reported log and a login/logout method.

RESULTS

The overall intervention effect demonstrated no statistical significance in knowledge scores from the baseline scores between the intervention and control group. The intervention group demonstrated higher learning efficiency in comparison to the control group.

CONCLUSION

The study demonstrated an infographic poster is as effective as an e-learning program on improving knowledge scores. However, in comparison to an e-learning program, an infographic poster is a more efficient way of learning.

RELEVANCE TO CLINICAL PRACTICE

Infographic posters can be an efficient educational modality to enhance healthcare professionals' knowledge and could be used as public health campaigns in clinical settings to educate the community.

Re-examining the testing effect as a learning strategy: the advantage of retrieval practice over concept mapping as a methodological artifact

Several previous studies appear to have demonstrated that studying with retrieval practice produces more learning than studying with concept mapping, a finding based on which an extended use of retrieval practice in educational practice was recommended. However, a closer examination of the methods used in these previous studies reveals a crucial confounding variable: Whereas participants in the concept mapping conditions performed a concept mapping task without any subsequent memorizing of the learning material, participants in the retrieval practice conditions performed not only retrieval practice but also an additional memorization task, which doubled the total memorization time. The present preregistered study examined whether the advantage observed in the retrieval practice condition over the concept mapping condition in previous studies was actually driven by additional memorization rather than by retrieval practice. While we replicated the previous finding that retrieval practice in combination with additional memorizing produces more learning than concept mapping without additional memorizing, this advantage of retrieval practice over concept mapping vanished when participants in the concept mapping condition, too, memorized the learning material after having created a concept map. These findings demonstrate that the assumed advantage of retrieval practice over concept mapping in fact represents a methodological artifact. Besides serving as a reminder of the importance of a solid methodology, the present study also illustrates the importance of using of an adequate terminology. Depicting a learning strategy condition as "retrieval practice" when the condition actually encompasses not only retrieval practice but also additional memorizing obfuscates the possibility that observed memory advantages may not be fueled by retrieval practice, i.e., the learning strategy as such. We conclude by giving an outlook on the ramifications of our findings for cognitive and educational psychology.

B, Park K. Evaluation framework for facilitating the technology transfers of universities: Focusing on the perspective of technology donors

Technological innovation and preoccupation with new markets through technological innovation have become critical factors in achieving success in the global market. Currently, companies cannot develop and commercialize all technologies. Therefore, the importance of technology transfers is rapidly increasing. Technology transfer is a crucial strategy adopted by organizations to remain innovative and competitive. However, Korea's technology transfer rate is only 37.9%. In particular, the technology transfer rate from universities to companies is lower than that from government-funded research institutes in Korea. Although the fundamental approach for resolving barriers to technology transfer have been studied, previous research has been conducted from a narrow definition of technology transfer. Furthermore, previous research has focused on analyzing the success factors of technology transfer, presenting technology transfer processes, or conducting case studies. Therefore, it is necessary to develop a technology donor diagnosis framework based on CSFs (Critical Success Factors) to eliminate obstacles to technology transfers. To lower the barriers to technology transfers, it is necessary to develop a strategy for a successful technology transfer based on the diagnosis of technology donors. This study develops a diagnosis framework for universities from the perspective of technology donors, implements and tests the framework using case studies, and proposes strategies for each stage of technology transfer growth. The framework is able to assess multidimensional perspectives, because CSFs and PMs were extracted based on BSC. Furthermore, by comparing the perspectives score of technology donors in different universities, technology donors can identify the areas in which each university is lacking in its current situation. Multidimensional diagnosis and aggregation score of technology donors offer to extract optimal CSFs for technology transfer activation for each growth stage.

Simulation in a blended learning curriculum for neonatology

Blended learning is a learner-centered educational method that combines online and traditional face-to-face educational strategies. Simulation is a commonly utilized platform for experiential learning and an ideal component of a blended learning curriculum. This section describes blended learning, including its strengths and limitations, educational frameworks, uses within health professions education, best practices, and challenges. Also included is a brief introduction to simulation-based education, along with theoretical and real-world examples of how simulation may be integrated into a blended learning curriculum. Examples of blended learning in Neonatal-Perinatal Medicine, specifically within the Neonatal Resuscitation Program, procedural skills training, and the National Neonatology Curriculum, are reviewed.

Teaching clinical hematology and leukocyte differentiation in veterinary medicine using virtual patients

Due to contact restrictions imposed because of the COVID-19 pandemic, we created a novel digital course on the Moodle learning platform for winter term in 2020. In the clinical pathology course (CPC) with hematological content, third-year students were able to work independently on 10 extra digital cases of internal medicine involving eight different animal species as a compensation for the reduction in traditional microscopy exercises. Each case presented was initiated using an anamnesis, also the participants to generate a differential blood count based on digitized leukocytes, previously been photographed using a microscope camera. The cases were successive and increased in complexity, for example through the increase in the number of different cell types to be differentiated. The participants had the opportunity to evaluate the course through a final module to rate user-friendliness and acceptance. The total results of the participants in 2021 were analyzed descriptively, focusing on success rates, time spent on the tasks, and number of attempts. A total of 237 (= 96%) of 247 students completed all cases, each assessing 1033 photographed blood cells in sum. The mean processing time was 22.48 min for a differentiation and the students spent an average of 1.48 attempts on it. A voluntary feedback form was completed by 192 (= 78%) students, with more than 95% rating the course positively in 12 evaluation questions, and 29 of 33 comments (= 87.88%) providing positive statements in a comment box. Suggestions for improvement primarily included more explanations on erythrocyte morphologies, followed by adjusting the difficulty level and improving the presentational set-up. Slight improvements in results, time spent on processing the tasks, and the number of attempts indicated an achievement of routine and confidence during the course and were associated with an increase of competency. The positive feedback showed a high acceptance of the digital format and students evaluated the course as improving the quality of teaching when combined with practical exercises.

Using tailored eHealth programmes to stimulate primary health care professionals' lifestyle counselling guideline adherence - Lessons learned from the STAR project

BACKGROUND

Although individually tailored eHealth programmes have shown to be effective in changing patient and citizen health behaviours, they have so far not been applied to lifestyle counselling guideline adherence in primary health care professionals beyond our STAR project. The programme aimed to support general practice nurses adhering to national smoking cessation counselling guidelines and showed encouraging positive impacts on both nurse and patient level.

OBJECTIVE

To identify lessons learned from our successful application of a tailored eHealth programme in primary health care.

METHODS

Triangulation of information from different sources collected throughout the project run time (e.g., project meetings, discussions with experts in the fields of computer tailoring, smoking cessation and professional education and interactions with general practice nurses).

RESULTS

We identify four lessons learned which developers and testers of tailored eHealth programmes in primary health care should consider, relating to 1) Choosing outcome measures, 2) Measuring outcomes, 3) Practical feedback application & Programme accessibility, and 4) Programme interaction.

PRACTICE IMPLICATIONS

We share this information in the hope that we will see more applications of this promising intervention strategy - that can build on our work - in the future.

Balancing the effectiveness and cost of online education: A preliminary realist economic evaluation

PURPOSE

While online learning for faculty development has grown substantially over recent decades, it has been further accelerated in the face of the worldwide pandemic. The effectiveness of online learning has been repeatedly established through systematic reviews and meta-analyses, yet questions remain about its cost-effectiveness. This study evaluates how synchronous online supervision training workshops and their cost-effectiveness might work, and in what contexts.

METHODS

We conducted preliminary realist economic evaluation including qualitative (13 realist interviews), and quantitative approaches (cost Ingredients method). We developed a cost-optimised model based on identified costs and cost-sensitive mechanisms.

RESULTS

We identified 14 recurring patterns (so-called demi-regularities) illustrating multiple online workshop outcomes (e.g. satisfaction, engagement, knowledge), generated by various mechanisms (e.g. online technology, mixed pedagogies involving didactic and active/experiential learning, peer learning), and triggered by two contexts (supervisor experience levels, and workplace location). Each workshop cost $302.92 per learner, but the optimised model including senior facilitators cost $305.70.

CONCLUSIONS

Our initial realist program theories were largely supported and refined. Although findings were largely concordant with previous literature, we illustrate how online workshop costs compare favourably with face-to-face alternatives. We encourage program developers to consider synchronous online learning for faculty development especially for remote learners, and in resource-constrained environments.

Saudi Arabian Students’ Beliefs about and Barriers to Online Education during the COVID-19 Pandemic

At a time when pandemics such as the novel coronavirus (COVID-19) spread rapidly, the deployment of online education is essential. However, to successfully leverage online education in such times, it is important to investigate learners’ motivations and beliefs about online education and associated barriers as well as the role of religious and social values. To investigate these motivations and beliefs, this study included semi-structured interviews with 10 female undergraduate students. These interviews explored the perceptions of students with regard to their engagement with online learning and assessment amid the COVID-19 pandemic in Saudi Arabia’s higher education system. The findings indicate that the challenges linked to the sudden shift in learning mode and changes in assessment techniques impacted students’ engagement with learning and assessment. The findings also indicate that personal challenges decreased the willingness of students to learn online, but that their beliefs about learning online were improved by the quality of online learning. The study identified that one of the most important elements of improving beliefs about online learning is open communication between students and instructors, as this contributes to shared understanding and acceptance. The results are presented and discussed in connection with current literature, research implications, and future directions.

Comparing computer-assisted learning activities for learning clinical neuroscience: a randomized control trial

BACKGROUND

Computer-assisted learning has been suggested to improve enjoyment and learning efficacy in medical education and more specifically, in neuroscience. These range from text-based websites to interactive electronic modules (eModules). It remains uncertain how these can best be implemented. To assess the effects of interactivity on learning perceptions and efficacy, we compared the utility of an eModule using virtual clinical cases and graphics against a Wikipedia-like page of matching content to teach clinical neuroscience: fundamentals of stroke and cerebrovascular anatomy.

METHODS

A randomized control trial of using an interactive eModule versus a Wikipedia-like page without interactivity was performed. Participants remotely accessed their allocated learning activity once, for approximately 30 min. The primary outcome was the difference in perceptions on enjoyability, engagement and usefulness. The secondary outcome was the difference in learning efficacy between the two learning activities. These were assessed using a Likert-scale survey and two knowledge quizzes: one immediately after the learning activity and one repeated eight weeks later. Assessments were analysed using Mann-Whitney U and T-tests respectively.

RESULTS

Thirty-two medical students participated: allocated evenly between the two groups through randomisation. The eModule was perceived as significantly more engaging (p = 0.0005), useful (p = 0.01) and enjoyable (p = 0.001) by students, with the main contributing factors being interactivity and clinical cases. After both learning activities, there was a significant decrease between the first and second quiz scores for both the eModule group (-16%, p = 0.001) and Wikipedia group (-17%, p = 0.003). There was no significant difference in quiz scores between the eModule and Wikipedia groups immediately afterwards (86% vs 85%, p = 0.8) or after eight weeks (71% vs 68%, p = 0.7).

CONCLUSION

Our study shows that increased student satisfaction associated with interactive computer-assisted learning in the form of an eModule does not translate into increased learning efficacy as compared to using a Wikipedia-like webpage. This suggests the matched content of the passive webpage provides a similar learning efficacy. Still, eModules can help motivate self-directed learners and overcome the perceived difficulty associated with neuroscience. As computer assisted learning continues to rapidly expand among medical schools, we suggest educators critically evaluate the usage and cost-benefit of eModules.

Could Gamification Designs Enhance Online Learning Through Personalization? Lessons from a Field Experiment

Online learning is of growing importance to institutions and learners, and the COVID-19 pandemic has underscored its importance even more. Because learner autonomy is relatively high in these online environments, they must engage in self-regulated learning processes to achieve successful learning outcomes, but studies show that most learners are not able to do so. Hence, in this longitudinal field experiment, using a massively open online course (MOOCs), a type of online learning environment, we investigate whether gamified interventions through the learning platform can foster learners to engage in self-regulated learning processes and improve their learning outcomes. We find that gamification interventions are indeed useful, but for these gamification interventions to succeed, they must be designed to provide personalized feedback to learners that match with their learning goal-orientation. Overall, our findings point to the fact that gamification designs in online learning platforms can enhance learners’ engagement and learning outcomes, but they must be personalized. A one-size-fits-all approach to gamification design in online learning just does not work and may even backfire to reduce the engagement of some learners.

Making Effective Educational Videos for Clinical Teaching

Prerecorded video content in medical education has become more common. Increasingly accessible technology coupled with the COVID-19 pandemic and subsequent need for distanced learning has greatly increased the interest in and need for high-quality video content. The use of short educational videos to augment other teaching methods has been shown to improve learners' experiences, knowledge retention, and understanding of content. Multiple studies have demonstrated that video education can be a highly effective tool for learning, particularly for hard-to-visualize processes and for procedural education. Videos allow learners to view content at their own pace and revisit materials on demand. In addition, well-designed videos can be repurposed by educators, ultimately reducing time needed to create high-quality educational content. Currently available technology allows educators to create high-quality videos at minimal cost and with a modest investment of time. This article details practical tips for creating high-yield educational videos.

A Tool for Designing and Studying Student-Centered Undergraduate Field Experiences: The UFERN Model

Undergraduate field experiences (UFEs), where students learn and sometimes live together in nature, are critical for the field-based science disciplines. The Undergraduate Field Experiences Research Network (UFERN) brings together UFE educators and researchers to improve and broaden participation in field education. Integrating research on UFEs and general STEM education and the expertise of the UFERN community, we present a model and evidence that describes the impact of intended student outcomes, student context factors, and program design factors on UFE student outcomes. The UFERN model is relevant for a diversity of UFE formats and the diverse students potentially engaged in them, and it supports the field science community to consider a range of ways students can engage with the field. The UFERN model can be applied to guide the design, implementation, and evaluation of student-centered UFEs and to guide research on the mechanisms underlying outcomes across UFE formats and disciplines.

Establishing the effectiveness of technology-enabled dementia education for health and social care practitioners: a systematic review

BACKGROUND

Dementia prevalence is increasing globally and yet evidence suggest that gaps exist in dementia-specific knowledge among health and social care practitioners. Technological modes of educational delivery may be as effective as traditional education and can provide practitioners with increased accessibility to dementia training. Benefits of digitally based dementia education have been established including pedagogical strategies that influence dementia knowledge and care attitudes. This review aimed to appraise and synthesise contemporary experimental evidence that evaluated technology-enabled dementia education for health and social care practitioners. Outcomes based on Kirkpatrick's Model were learner satisfaction; knowledge, skills, and attitudes; behaviours; and results.

METHODS

MEDLINE, CINAHL, and Web of Science were among 8 bibliographic databases searched from January 2005 until February 2020. Keywords included dementia and education (and terms for technological modes of education, learning, or training). We included experimental and quasi-experimental studies. Medical Education Research Study Quality Instrument established the overall quality of included studies and pragmatic application of Mixed Methods Appraisal Tool established individual study quality and highlighted methodological features of educational research. Narrative synthesis was conducted as heterogeneous outcome data precluded meta-analysis.

RESULTS

We identified 21 relevant studies: 16 evaluated online dementia education and 5 evaluated computer-based approaches. Most studies used before-after designs and study quality was moderate overall. Most studies reported knowledge-based outcomes with statistically significant findings favouring the training interventions. Positive effects were also observed in studies measuring skills and attitudinal change. Fewer studies reported significant findings for behavioural change and results due to training. Case-based instruction was a frequently described instructional strategy in online dementia education and videos were common information delivery modes. CD-ROM training and simulation activities were described in computer-based dementia education.

DISCUSSION

Future emphasis must be placed on teaching and learning methods within technology-enabled dementia education which should be role relevant and incorporate active and interactive learning strategies. Future evaluations will require contextually relevant research methodologies with capacity to address challenges presented by these complex educational programmes and multi-component characteristics.

SYSTEMATIC REVIEW REGISTRATION

This systematic review is based on a protocol registered with PROSPERO ( CRD42018115378 ).

Effectiveness of the CDC HEADS UP online training on healthcare providers' mTBI knowledge and self-efficacy

BACKGROUND

Many healthcare providers do not consistently implement recommendations contained in clinical guidelines on mild traumatic brain injury (mTBI). As such, the Centers for Disease Control and Prevention (CDC) created the HEADS UP to Healthcare Providers online training to promote uptake of five key recommendations in the CDC Pediatric mTBI Guideline.

METHODS

Using data from modules in the CDC HEADS UP to Healthcare Providers online training, healthcare providers' self-reported knowledge and self-efficacy prior to and immediately following completion of the training was analyzed.

RESULTS

Improvements for 8 out of the 10 knowledge questions had a high level of practical significance. The knowledge question with the highest level of practical significance pre- to post-test improvement was for the key guideline recommendation on neuroimaging (pre-test correct: 70.2%; post-test correct: 87.8%; (p < 0.0001, Cohen's g = 0.39). Four out of the six questions had a self-efficacy level increase of a high level of practical significance (r > 0.50) between the pre- and post-tests. The self-efficacy question with pre- to post-test improvement with the highest level of practical significance was "I am confident in my ability to manage the return to sports progression for my patients" (p < 0.001; r = 0.54).

CONCLUSIONS

The HEADS UP to Healthcare Providers online training led to significant improvements in knowledge and self-efficacy related to mTBI diagnosis and management. Expanded use of this training among healthcare providers who commonly provide care for pediatric patients with mTBI may be beneficial. Practical Applications: This study highlights several factors guideline developers may take into consideration when creating an implementation tool, such as using health behavior theories, working with partners and key stakeholders, and focusing on digital-based tools.

Self-Regulation for and of Learning: Student Insights for Online Success in a Bachelor of Nursing Program in Regional Australia

The blended online digital (BOLD) approach to teaching is popular within many universities. Despite this popularity, our understanding of the experiences of students making the transition to online learning is limited, specifically an examination of those elements associated with success. The aim of this study is to explore the experiences of students transitioning from a traditional mode of delivery to a more online approach in an inaugural BOLD Bachelor of Nursing program at a regional multi-campus institution in Victoria, Australia. Fifteen students across two regional campuses participated in one of four focus groups. This qualitative exploration of students’ experience contributes to contemporary insights into how we might begin to develop programs of study that help students develop self-regulation. A modified method of thematic analysis of phenomenological data was employed to analyse the focus group interview data to identify themes that represent the meaning of the transition experience for students. This qualitative exploration of students’ experience contributes to contemporary insights into how we might begin to develop programs of study that help students develop self-regulation.

Structured and evidence-based training of technical skills in respiratory medicine and thoracic surgery

Within the last decade, the number of technical procedures in respiratory medicine and thoracic surgery has grown and created a higher demand for effective and evidence-based education. Today, trainees are often allowed to perform procedures unsupervised on patients after obtaining a course certificate from a theoretic course and having performed a fixed number of supervised procedures. However, these methods do not ensure adequate competence. Well-structured and effective educational programmes including validated tests are needed to reduce economic expenses, optimize time spend, and ensure patient safety. The aim of this article is to summarize current state of educational strategies for technical procedures within respiratory medicine and thoracic surgery. Thus, to discuss future recommendations for curriculum development and assessment of competences based on Kern’s framework. The approach by Kern consists of six topics, which needs to be considered and evaluated and in order to educate physicians and surgeons most effective and evidence-based. We present a practical guide contributing to future educators’ considerations on (I) problem identification and general needs assessment, (II) targeted needs assessment, (III) goals and objectives, (IV) educational strategies, (V) implementation, and finally (VI) evaluation and feedback.

American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians-part II: recommendations

Point-of-care ultrasound (POCUS) is a critical skill for all regional anesthesiologists and pain physicians to help diagnose relevant complications related to routine practice and guide perioperative management. In an effort to inform the regional anesthesia and pain community as well as address a need for structured education and training, the American Society of Regional Anesthesia and Pain Medicine Society (ASRA) commissioned this narrative review to provide recommendations for POCUS. The recommendations were written by content and educational experts and were approved by the guidelines committee and the Board of Directors of the ASRA. In part II of this two-part series, learning goals and objectives were identified and outlined for achieving competency in the use of POCUS, specifically, airway ultrasound, lung ultrasound, gastric ultrasound, the focus assessment with sonography for trauma exam, and focused cardiac ultrasound, in the perioperative and chronic pain setting. It also discusses barriers to POCUS education and training and proposes a list of educational resources. For each POCUS section, learning goals and specific skills were presented in the Indication, Acquisition, Interpretation, and Medical decision-making framework.

Nurses' Attitudes Toward Lifelong Learning via New Technologies

Introduction: Lifelong professional education is considered as a qualitative indicator in the health discipline, as it can improve health professionals' knowledge and skills, as well as nursing care. Purpose: The purpose of this original research is to examine and record the attitudes and behavior of nurses working in state-run hospitals in the Municipality of Thessaloniki regarding lifelong education through new technologies. Identification of nurses' motivations for lifelong distance education, recording of nurses' perception of the need for continuing nursing education, and determining how nurses pursue lifelong learning are the objectives of this study. Methodology: The study was conducted between January and March 2019. The sample of the study consisted of 124 nurses (n = 124) from three state hospitals of the Municipality of Thessaloniki. A questionnaire consisting of 5 parts was used as a research tool. SPSS 23 statistical software platform was used for statistical analysis. Results: The sample consisted of 124 participants, 12 were men and 112 were women. The mean age of the participants was 42.37 years and the mean experience in the field was 16.78 years. Two main reasons for continuing education were attributed to the upgrade of the nursing profession and the need to improve the quality of care provided. Conclusions: Nurses believe that continuing education is essential and their professional knowledge must periodically be enriched and renewed.

The Impact of a Virtual Radiology Medical Student Rotation: Maintaining Engagement During COVID-19 Mitigation

Introduction

The purpose of this study is to introduce a virtual radiology rotation curriculum that is being used to safely maintain medical student and intern education and engagement with the Department of Radiology at Walter Reed National Military Medical Center during coronavirus disease 2019 (COVID-19) mitigation.

Materials and Methods

The curriculum is designed as a 4-week block with each week representing one of the four highest yield radiology subspecialties for medical students; neuroradiology, thoracic radiology, body radiology, and musculoskeletal radiology. A subspecialist radiologist from each section was identified as a primary mentor and tasked with designing a daily schedule for medical students and interns. The first 2 months of virtual rotators were surveyed to assess the effectiveness of the course.

Results

Thirty-five of 41 rotators responded to the survey, a response rate of 85%. Thirty-one of 35 (89%) of the rotators gave this virtual elective rotation a positive rating, with 16 trainees scoring the course as 4 out of 5 and 15 trainees selecting 5 out of 5. Four respondents selected 3 out of 5. Five out of 5 respondents who had experienced an in-person radiology elective rotation before this virtual rotation rated the virtual elective as more educational than the in-person rotation. We found the 4-week subspecialist mentor-based structure to be highly versatile, allowing us to simultaneously accommodate multiple groups of full or partial block rotators throughout COVID-19 mitigation.

Conclusion

A virtual rotation curriculum is a viable method of maintaining medical student and intern education and engagement with the department of radiology during COVID-19 mitigation.

Aligning Practice Data and Institution-specific CPD: Medical Quality Management as the Driver for an eLearning Development Process

For hospital physicians, alignment of Continuing Professional Development (CPD) with quality improvement efforts is often absent or rudimentary. The purpose of this study was to evaluate a CPD development process that created accessible learning opportunities and aligned CPD with practice data. We conducted a chart audit to identify patient safety and quality of care issues within the institution, then established an eLearning approach that supported quick and cost effective development of high-quality interactive CPD opportunities. We tested a pilot module on the management of common infections in sub-acute care settings with fifteen (68%) residents and three staff physicians to evaluate the approach. One resident and three staff agreed to a follow-up interview. The satisfaction survey indicated that participants felt the content was generally appropriate and the module well designed. Significant improvements to knowledge were reported in the multi-drug resistance (Mean Difference = 25%, p = 0.002), infection management (MD = 32%, p < 0.001), and cellulitis risk factor (MD = 22%, p = 0.02) questions, as well as in the overall score (MD = 19%, p < 0.001). In terms of confidence in their answers, the mean rating pre-module was 3.17, rising significantly to 3.92 post-module (p < 0.001). In this way, collaboration between quality management and education committees allowed for the development of relevant CPD for physicians, with eLearning providing a timely and accessible way to deliver training on emerging issues.

Learning With Patients, Students, and Peers: Continuing Professional Development in the Solo Practitioner Workplace

Conceptualizations of workplace learning have moved from knowledge acquisition to learning as participation in the practices and cultures of the workplace environment. Along with this has come an appreciation of applicability of sociocultural learning theories, which frame learning as occurring within "communities of practice" or learning being "situated" within a workplace environment where collaboration and social interaction are fundamental to the learning process. These conceptualizations of workplace learning are ideally suited to health professions where learners are supervised in clinical work environments and then continue to work in team-based environments as graduates. However, what happens to workplace learning for novice practitioners who have limited periods of clinical supervision and then graduate into solo or small group practices (which may also be in rural or remote locations) and embark on long working careers without supervision? This paper argues workplace learning needs to be scaffolded and supported to reach its full potential in these environments. Drawing on workplace-based learning theory, we highlight the ubiquitous nature of learning in the workplace, the importance of active engagement, reflection, and individual meaning making. Through this reframing of traditional notions of continuing professional development, we emphasize the importance of patients, students, and other practitioners as partners in workplace learning for solo practitioners. We also focus on the role of educators, professional associations, and regulators in helping solo practitioners recognize, access, and maximize the learning opportunities inherent in relatively isolated practice environments.

How Do Smart Device Apps for Diabetes Self-Management Correspond with Theoretical Indicators of Empowerment? An Analysis of App Features

OBJECTIVES

Smart device apps for diabetes have the potential to support patients in their daily disease management. However, uncertainty exists regarding their suitability for empowering patients to improve self-management behaviors. This paper addresses a general research gap regarding theoretically based examinations of empowerment in diabetes research, by examining how diabetes app features correspond with conceptual indicators of empowerment.

METHODS

We examined features of 121 apps for diabetes self-management available in Singapore, with the second highest proportion of diabetes among developed nations, for psychological empowerment (feeling of empowerment) and for behavioral empowerment (social support).

RESULTS

Diabetes apps studied offered a narrow range of features, with limited feature-sets corresponding to indicators of empowerment. Customization as a strategy to improve perceived relevance of diabetes self-management as an indicator of psychological empowerment was especially limited. Moreover, there was a lack of features supporting patients' communication with healthcare professionals and within their private social networks.

CONCLUSIONS

Mobile apps for diabetes self-management failed to provide relevant features for empowering patients. Specific practical recommendations target improved adoption, sustained usage, and effectiveness of diabetes self-management apps.

Association of Online Learning Behavior and Learning Outcomes for Medical Students: Large-Scale Usage Data Analysis

BACKGROUND

Digital learning environments have become very common in the training of medical professionals, and students often use such platforms for exam preparation. Multiple choice questions (MCQs) are a common format in medical exams and are used by students to prepare for said exams.

OBJECTIVE

We aimed to examine whether particular learning activities contributed more strongly than others to users' exam performance.

METHODS

We analyzed data from users of an online platform that provides learning materials for medical students in preparation for their final exams. We analyzed whether the number of learning cards viewed and the number of MCQs taken were positively related to learning outcomes. We also examined whether viewing learning cards or answering MCQs was more effective. Finally, we tested whether taking individual notes predicted learning outcomes, and whether taking notes had an effect after controlling for the effects of learning cards and MCQs. Our analyses from the online platform Amboss are based on user activity data, which supplied the number of learning cards studied and test questions answered. We also included the number of notes from each of those 23,633 users who had studied at least 200 learning cards and had answered at least 1000 test exam questions in the 180 days before their state exam. The activity data for this analysis was collected retrospectively, using Amboss archival usage data from April 2014 to April 2017. Learning outcomes were measured using the final state exam scores that were calculated by using the answers voluntarily entered by the participants.

RESULTS

We found correlations between the number of cards studied (r=.22; P<.001) and the number of test questions that had been answered (r=.23; P<.001) with the percentage of correct answers in the learners' medical exams. The number of test questions answered still yielded a significant effect, even after controlling for the number of learning cards studied using a hierarchical regression analysis (β=.14; P<.001; ΔR²=.017; P<.001). We found a negative interaction between the number of learning cards and MCQs, indicating that users with high scores for learning cards and MCQs had the highest exam scores. Those 8040 participants who had taken at least one note had a higher percentage of correct answers (80.94%; SD=7.44) than those who had not taken any notes (78.73%; SD=7.80; t₂₃₆₃₁=20.95; P<.001). In a stepwise regression, the number of notes the participants had taken predicted the percentage of correct answers over and above the effect of the number of learning cards studied and of the number of test questions entered in step one (β=.06; P<.001; ΔR²=.004; P<.001).

CONCLUSIONS

These results show that online learning platforms are particularly helpful whenever learners engage in active elaboration in learning material, such as by answering MCQs or taking notes.

Does self-modulated learning vs. algorithm-regulated learning of dermatology morphology affect learning efficiency of medical students?

BACKGROUND

Deliberate practice is an important method of skill acquisition and is under-utilized in dermatology training. We delivered a dermatologic morphology training module with immediate feedback for first year medical students. Our goal was to determine whether there are differences in accuracy and learning efficiency between self- regulated and algorithm-regulated groups.

METHODS

First year medical students at the University of Calgary completed a dermatologic morphology module. We randomly assigned them to either a self-regulated arm (students removed cases from the practice pool at their discretion) or an algorithm-regulated arm (an algorithm determined when a case would be removed). We then administered a pre-survey, pre-test, post-test, and post-survey. Data collected included mean diagnostic accuracy of the practice sessions and tests, and the time spent practicing. The surveys assessed demographic data and student satisfaction.

RESULTS

Students in the algorithm-regulated arm completed more cases than the self-regulated arm (52.9 vs. 29.3, p<0.001) and spent twice as much time completing the module than the self-regulated participants (34.3 vs. 17.0 min., p<0.001). Mean scores were equivalent between the algorithm- and self-regulated groups for the pre-test (63% vs. 66%, n = 54) and post-test (90% vs. 86%, n = 10), respectively. Both arms demonstrated statistically significant improvement in the post-test.

CONCLUSION

Both the self-regulated and algorithm-regulated arms improved at post-test. Students spent significantly less time practicing in the self-directed arm, suggesting it was more efficient.

Comparison of healthcare professionals' motivations for using different online learning materials

IMPORTANCE

Online learning is increasingly prevalent throughout all stages of medical education. There is little published literature exploring what motivates healthcare professionals to engage with different types of e-learning content. Learner motivations must be understood in order to design effective educational solutions and to optimize the overall online learning experience.

OBJECTIVE

Examine engagement, satisfaction, and motivations of healthcare professionals using OPENPediatrics, an open-access medical e-learning platform.

METHODS

Retrospective analysis of online survey data. Users were asked to report engagement and satisfaction with the platform, as well as to select motivations for using different types of content on the site: Courses, Simulators, and World Shared Practice Forum videos.

RESULTS

Majority of respondents were physicians and nurses in North America and Europe. Overall satisfaction with the platform was high. Most frequently cited motivations for using Courses and Simulators were: learn basic and in-depth information around topics, and learn how to deliver safer or more effective patient care. For World Shared Practice Forum videos, most commonly cited motivations were: learn in-depth information about a topic, learn the latest advances or developments in an area, and learn how to deliver safer or more effective patient care.

INTERPRETATION

We appreciated both commonalities and differences in learning motivations among clinicians accessing different kinds of medical e-learning content. Respondents were consistently motivated to learn in order to deliver safer or more effective patient care, but they reported using different types of educational content depending on whether they were learning basic information versus updating or changing their knowledge.

Portable Video Media Versus Standard Verbal Communication in Surgical Teaching: A Prospective, Multicenter, and Randomized Controlled Crossover Trial

OBJECTIVE

This study aims to evaluate the effectiveness of portable video media (PVM) compared to standard verbal communication (SVC) as a novel adjunct for surgical education of junior medical officers and medical students, in terms of knowledge acquisition and participant satisfaction.

BACKGROUND

The effective, continued education of final year medical students and junior doctors is the foundation of quality healthcare. The development of new media technologies and rapid internet streaming has resulted in an opportunity for the integration of PVM into medical education. PVM is an educational platform with the advantage of being standardized, efficient, and readily available.

DESIGN

This is a multicenter, prospective, and randomized controlled crossover study. Participants completed a preintervention knowledge test and were then randomized in an allocation ratio of 1:1 to receive surgical education regarding cystoscopy and ureteric stenting for acute renal colic via either PVM or SVC. A 32-point knowledge test and a modified Client Satisfaction Questionnaire-8 were then administered and the participants were then crossed over to the other educational method. The knowledge and satisfaction tests were then readministered.

RESULTS

Fifty-four participants were recruited for this study with 27 participants in each group. Both groups had a 18% to 20% increase in knowledge scores following the first intervention p < 0.001 and on crossover there was a further 4% increase in knowledge scores, p < 0.01. There was no significant difference between the groups in knowledge scores before intervention, p = 0.23 after first intervention p = 0.74 or following crossover p = 0.09. After first intervention, participants in the group receiving PVM education first had a significant 8% higher satisfaction score compared to the SVC group, p = 0.023.

CONCLUSIONS

Our study has shown that PVM shows similar efficacy in information uptake to traditional forms of education. Furthermore, PVM was shown to have higher satisfaction scores compared to SVC. Further studies will need to evaluate the use of PVM for education in other surgical and medical domains and assess the long-term knowledge retention.

The effectiveness of web-based learning in supporting the development of nursing students' practical skills during clinical placements: A qualitative study

Web-based learning, on its own or in combination with traditional teaching methods, has become a consolidated practice in many countries, and has been described as a valid and effective method that supports practical learning in undergraduate nursing students. The aim of this study was to explore the perception and effectiveness of web-based learning in facilitating the development of clinical skills in undergraduate nursing students. A qualitative descriptive study was conducted including online videos in three nursing schools of a university in Northern Italy. The participants were 26 undergraduate nursing students. A dedicated website was built including four videos and the respective checklists of four nursing techniques: insertion of a urinary catheter; insertion of a nasogastric tube; taking a blood sample; and the insertion of a peripheral intravenous line. Three Focus Groups were conducted, one for each nursing school. Thanks to its ease of use and unlimited access, web-based learning effectively supported students' clinical learning process by offering additional virtual visual support. Web-based learning could be effectively used to reduce the gap between theory and practice, and even as an upgrade for already qualified nurses.

A protocol for designing online training to support the implementation of community-based interventions

Training program implementers through online methods represents a way of facilitating the widespread implementation of community-based interventions that is more financially and logistically feasible than traditional in-person training methods. However, there are few evidence-informed protocols or models that can guide the development of online training content in a way that is consistent with instructional best practices. This paper presents an evidence-informed protocol for developing a training website, or online training platform, to support the implementation of community-based interventions at scale, which was informed by a critical analysis of the instructional design literature and our experiences developing an online training platform for the HealtheStepsTM Lifestyle Prescription Program. The protocol is an operationalization of the ADDIE model of instructional design, and details the analysis, design, development, implementation, and evaluation stages of the process. Examples from the HealtheStepsTM program are used to illustrate the use of the protocol in practice. The protocol emphasizes the need for rigorous analysis of the target audience and a multidisciplinary literature base drawing from instructional design and implementation science. It can be used by researchers to guide the development of online training platforms to support the widespread implementation of evidence-based health interventions, thus increasing their public health impact.

Implementing an arts-based intervention for patients with end-stage kidney disease whilst receiving haemodialysis: a feasibility study protocol

BACKGROUND

End-stage kidney disease is a life-changing illness. Many patients require haemodialysis, a treatment that impacts profoundly on quality of life and mental health. Arts-based interventions have been used in other healthcare settings to improve mental health and quality of life; therefore, they may help address the impact of haemodialysis by improving these outcomes. However, there is a lack of evidence assessing their effectiveness in this population and few randomised controlled trials (RCTs) evaluating the effectiveness of complex arts-based interventions.

METHODS

The aims of this study are to establish the feasibility of a cluster RCT of an arts-based intervention for patients with end-stage kidney disease whilst receiving haemodialysis through a cluster randomised pilot study, explore the acceptability of the intervention with a process evaluation and explore the feasibility of an economic evaluation. The study will have three phases. The first phase consists of a cluster randomised pilot study to establish recruitment, participation and retention rates. This will involve the recruitment of 30 participants who will be randomly allocated through cluster randomisation according to shift pattern to experimental and control group. The second phase will be a qualitative process evaluation to establish the acceptability of the intervention within a clinical setting. This will involve semi-structured interviews with 13 patients and three focus groups with healthcare professionals. The third phase will be a feasibility economic evaluation to establish the best methods for data collection within a future cluster RCT.

DISCUSSION

Arts-based interventions have been shown to improve quality of life in healthcare settings, but there is a lack of evidence evaluating arts-based interventions for patients receiving haemodialysis. This study aims to assess the feasibility of a future cluster RCT assessing the impact of an arts-based intervention on the wellbeing and mental health of patients receiving haemodialysis and identify the key factors leading to successful implementation. The hope is this study will inform a trial that can influence future healthcare policy by providing robust evidence for arts-based interventions within the haemodialysis setting.

TRIAL REGISTRATION

The trial was prospectively registered on clinicaltrials.gov on 14/8/2018, registration number NCT03629496.

Lung ultrasound training: a systematic review of published literature in clinical lung ultrasound training

Background

Clinical lung ultrasound examinations are widely used in the primary assessment or monitoring of patients with dyspnoea or respiratory failure. Despite being increasingly implemented, there is no international consensus on education, assessment of competencies, and certification. Today, training is usually based on the concept of mastery learning, but is often unstructured and limited by bustle in a clinical daily life. The aim of the systematic review is to provide an overview of published learning studies in clinical lung ultrasound, and to collect evidence for future recommendations in lung ultrasound education and certification.

Methods

According to PRISMA guidelines, three databases (PubMed, Embase, Cochrane Library) were searched, and two reviewers examined the results for eligibility. Included publications were described and assessed for level of evidence and risk of bias according to guidelines from Oxford Centre for Evidence-Based Medicine and Cochrane Collaboration Tool for Risk of Bias assessment.

Results

Of 7796 studies screened, 16 studies were included. Twelve pre- and post-test studies, three descriptive studies and one randomized controlled trial were identified. Seven studies included web-based or online modalities, while remaining used didactic or classroom-based lectures. Twelve (75%) studies provided hands-on sessions, and of these, 11 assessed participants’ hands-on skills. None of the studies used validated neither written nor practical assessment. The highest level of evidence score was 2 (n = 1), remaining scored 4 (n = 15). Risk of bias was assessed high in 11 of 16 studies (68.75%).

Conclusion

All educational methods proved increased theoretical and practical knowledge obtained at the ultrasound courses, but the included studies were substantial heterogeneous in setup, learning-, and assessment methods, and outcome measures. On behalf of current published studies, it was not possible to construct clear guidelines for the future education and certification in clinical lung ultrasound, but the use of different hands-on training facilities tends to contribute to different aspects of the learning process. This systematic review proves a lack of learning studies within this content, and research with validated theoretical and practical tests for assessment is desired.

Evaluating the Effect of a Web-Based E-Learning Tool for Health Professional Education on Clinical Vancomycin Use: Comparative Study

BACKGROUND

Internet-based learning for health professional education is increasing. It offers advantages over traditional learning approaches, as it enables learning to be completed at a time convenient to the user and improves access where facilities are geographically disparate. We developed and implemented the Vancomycin Interactive (VI) e-learning tool to improve knowledge on the clinical use of the antibiotic vancomycin, which is commonly used for treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA).

OBJECTIVE

The aims of this study were to evaluate the effect of the VI e-learning tool on (1) survey knowledge scores and (2) clinical use of vancomycin among health professionals.

METHODS

We conducted a comparative pre-post intervention study across the 14 hospitals of two health districts in New South Wales, Australia. A knowledge survey was completed by nurses, doctors, and pharmacists before and after release of a Web-based e-learning tool. Survey scores were compared with those obtained following traditional education in the form of an email intervention. Survey questions related to dosing, administration, and monitoring of vancomycin. Outcome measures were survey knowledge scores among the three health professional groups, vancomycin plasma trough levels, and vancomycin approvals recorded on a computerized clinical decision support system.

RESULTS

Survey response rates were low at 26.87% (577/2147) preintervention and 8.24% (177/2147) postintervention. The VI was associated with an increase in knowledge scores (maximum score=5) among nurses (median 2, IQR 1-2 to median 2, IQR 1-3; P<.001), but not among other professional groups. The comparator email intervention was associated with an increase in knowledge scores among doctors (median 3, IQR 2-4 to median 4, IQR 2-4; P=.04). Participants who referred to Web-based resources while completing the e-learning tool achieved higher overall scores than those who did not (P<.001). The e-learning tool was not shown to be significantly more effective than the comparator email in the clinical use of vancomycin, as measured by plasma levels within the therapeutic range.

CONCLUSIONS

The e-learning tool was associated with improved knowledge scores among nurses, whereas the comparator email was associated with improved scores among doctors. This implies that different strategies may be required for optimizing the effectiveness of education among different health professional groups. Low survey response rates limited conclusions regarding the tool's effectiveness. Improvements to design and evaluation methodology may increase the likelihood of a demonstrable effect from e-learning tools in the future.

E-learning for health professionals

BACKGROUND

The use of e-learning, defined as any educational intervention mediated electronically via the Internet, has steadily increased among health professionals worldwide. Several studies have attempted to measure the effects of e-learning in medical practice, which has often been associated with large positive effects when compared to no intervention and with small positive effects when compared with traditional learning (without access to e-learning). However, results are not conclusive.

OBJECTIVES

To assess the effects of e-learning programmes versus traditional learning in licensed health professionals for improving patient outcomes or health professionals' behaviours, skills and knowledge.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, five other databases and three trial registers up to July 2016, without any restrictions based on language or status of publication. We examined the reference lists of the included studies and other relevant reviews. If necessary, we contacted the study authors to collect additional information on studies.

SELECTION CRITERIA

Randomised trials assessing the effectiveness of e-learning versus traditional learning for health professionals. We excluded non-randomised trials and trials involving undergraduate health professionals.

DATA COLLECTION AND ANALYSIS

Two authors independently selected studies, extracted data and assessed risk of bias. We graded the certainty of evidence for each outcome using the GRADE approach and standardised the outcome effects using relative risks (risk ratio (RR) or odds ratio (OR)) or standardised mean difference (SMD) when possible.

MAIN RESULTS

We included 16 randomised trials involving 5679 licensed health professionals (4759 mixed health professionals, 587 nurses, 300 doctors and 33 childcare health consultants).When compared with traditional learning at 12-month follow-up, low-certainty evidence suggests that e-learning may make little or no difference for the following patient outcomes: the proportion of patients with low-density lipoprotein (LDL) cholesterol of less than 100 mg/dL (adjusted difference 4.0%, 95% confidence interval (CI) -0.3 to 7.9, N = 6399 patients, 1 study) and the proportion with glycated haemoglobin level of less than 8% (adjusted difference 4.6%, 95% CI -1.5 to 9.8, 3114 patients, 1 study). At 3- to 12-month follow-up, low-certainty evidence indicates that e-learning may make little or no difference on the following behaviours in health professionals: screening for dyslipidaemia (OR 0.90, 95% CI 0.77 to 1.06, 6027 patients, 2 studies) and treatment for dyslipidaemia (OR 1.15, 95% CI 0.89 to 1.48, 5491 patients, 2 studies). It is uncertain whether e-learning improves or reduces health professionals' skills (2912 health professionals; 6 studies; very low-certainty evidence), and it may make little or no difference in health professionals' knowledge (3236 participants; 11 studies; low-certainty evidence).Due to the paucity of studies and data, we were unable to explore differences in effects across different subgroups. Owing to poor reporting, we were unable to collect sufficient information to complete a meaningful 'Risk of bias' assessment for most of the quality criteria. We evaluated the risk of bias as unclear for most studies, but we classified the largest trial as being at low risk of bias. Missing data represented a potential source of bias in several studies.

AUTHORS' CONCLUSIONS

When compared to traditional learning, e-learning may make little or no difference in patient outcomes or health professionals' behaviours, skills or knowledge. Even if e-learning could be more successful than traditional learning in particular medical education settings, general claims of it as inherently more effective than traditional learning may be misleading.

Flipping the Classroom in Medical Student Education: Does Priming Work?

Introduction

The emergency medicine (EM) clerkship curriculum at Los Angeles County + University of Southern California Medical Center includes monthly lectures on pediatric fever and shortness of breath (SOB). This educational innovation evaluated if learning could be enhanced by "priming" the students with educational online videos prior to an in-class session. Factors that impacted completion rates were also evaluated (planned specialty and time given for video viewing).

Methods

Twenty-minute videos were to be viewed prior to the didactic session. Students were assigned to either the fever or SOB group and received links to those respective videos. All participating students took a pre-test prior to viewing the online lectures. For analysis, test scores were placed into concordant groups (test results on fever questions in the group assigned the fever video and test results on SOB questions in the group assigned the SOB video) and discordant groups (crossover between video assigned and topic tested). Each subject contributed one set of concordant results and one set of discordant results. Descriptive statistics were performed with the Mann-Whitney U test. Lecture links were distributed to students two weeks prior to the in-class session for seven months and three days prior to the in-class session for eight months (in which both groups included both EM-bound and non-EM bound students).

Results

In the fifteen-month study period, 64% of students rotating through the EM elective prepared for the in class session by watching the videos. During ten months where exclusively EM-bound students were rotating (n=144), 71.5% of students viewed the lectures. In four months where students were not EM-bound (n=54), 55.6% of students viewed the lectures (p=0.033). Participation was 60.2% when lecture links were given three days in advance and 68.7% when links were given two weeks in advance (p=0.197). In the analysis of concordant scores, the pre-test averaged 56.7% correct, the immediate post-test averaged 78.1% correct, and the delayed post-test was 67.2%. In the discordant groups, the pretest averaged 51.9%, the immediate posttest was 67.1% and the delayed by 68.8%. In the concordant groups, the immediate post-test scores improved by 21.4%, compared with 15.2% in the discordant groups (p = 0.655). In the delayed post-test the concordant scores improved by 10.5% and discordant scores by 16.9 percent (p=0.609). Sixty-two percent of students surveyed preferred the format of online videos with in-class case discussion to a traditional lecture format.

Conclusion

Immediate post-tests and delayed post-tests improved but priming was not demonstrated to be a statistically superior educational method in this study. Medical student completion of the preparatory materials for the EM rotation session increased when the students were EM-bound. Participation rates were not significantly different when given at two weeks versus three days.

Problem-based, peer-to-peer global mental health e-learning between the UK and Somaliland: a pilot study

BACKGROUND

WHO's mental health gap action programme intervention guide (mhGAP-IG) is an evidence-based tool aimed at front-line health workers in low-income and middle-income countries (LMICs). Its potential to improve global mental health education, especially through digital technologies, has been little studied. Problem-based learning (PBL) is usually conducted face-to-face, but its remote application could facilitate cross-cultural education.

OBJECTIVE

To evaluate PBL, applied to peer-to-peer global mental health e-learning (Aqoon), using mhGAP-IG.

METHODS

Twelve pairs of UK and Somaliland medical students completed the full programme. Participants self-directedly met online, via the low-bandwidth Medicine Africa website, for PBL-style tutorials focused on modules of the mhGAP-IG, V.2.0. Preparticipation and postparticipation surveys used mixed methods to evaluate Aqoon, including the Attitudes Toward Psychiatry (ATP-30) instrument.

FINDINGS

Median ATP-30 scores for Somaliland (82.0 vs 95.0, p=0.003) and UK students (82.0 vs 95.0, p=0.011) improved significantly following Aqoon. Qualitative feedback showed that participants valued peer connectivity and learning about cultural and psychosocial differences in their partner's country. Somaliland students were motivated by clinical learning and UK students by global health education. Feedback on the PBL structure was positive.

CONCLUSIONS

Digital PBL represents an innovative method to extend the benefits of mhGAP-IG beyond front-line clinical staff, to healthcare students in LMICs.

CLINICAL IMPLICATIONS

Educational resource limitations in LMICs may be overcome using digital platforms and PBL. Replication with non-medical healthcare students is the next step for this model to explore Aqoon's relevance to pressing global mental health workforce challenges.

E-learning in graduate medical education: survey of residency program directors

BACKGROUND

E-learning-the use of Internet technologies to enhance knowledge and performance-has become a widely accepted instructional approach. Little is known about the current use of e-learning in postgraduate medical education. To determine utilization of e-learning by United States internal medicine residency programs, program director (PD) perceptions of e-learning, and associations between e-learning use and residency program characteristics.

METHODS

We conducted a national survey in collaboration with the Association of Program Directors in Internal Medicine of all United States internal medicine residency programs.

RESULTS

Of the 368 PDs, 214 (58.2%) completed the e-learning survey. Use of synchronous e-learning at least sometimes, somewhat often, or very often was reported by 85 (39.7%); 153 programs (71.5%) use asynchronous e-learning at least sometimes, somewhat often, or very often. Most programs (168; 79%) do not have a budget to integrate e-learning. Mean (SD) scores for the PD perceptions of e-learning ranged from 3.01 (0.94) to 3.86 (0.72) on a 5-point scale. The odds of synchronous e-learning use were higher in programs with a budget for its implementation (odds ratio, 3.0 [95% CI, 1.04-8.7]; P = .04).

CONCLUSIONS

Residency programs could be better resourced to integrate e-learning technologies. Asynchronous e-learning was used more than synchronous, which may be to accommodate busy resident schedules and duty-hour restrictions. PD perceptions of e-learning are relatively moderate and future research should determine whether PD reluctance to adopt e-learning is based on unawareness of the evidence, perceptions that e-learning is expensive, or judgments about value versus effectiveness.

A Culturally Targeted Website for Hispanics/Latinos About Living Kidney Donation and Transplantation: A Randomized Controlled Trial of Increased Knowledge

BACKGROUND

Hispanics/Latinos receive disproportionately fewer living donor kidney transplantations (LDKTs) than non-Hispanic whites. We conducted a multisite, randomized controlled trial to evaluate the efficacy of exposure to a bilingual, culturally targeted website, Infórmate, for increasing Hispanics' knowledge about LDKT.

METHODS

Hispanic patients initiating transplant evaluation and their family/friends at 2 transplant centers were randomized to view Infórmate before attending routine transplant education sessions; usual care controls only attended education sessions. All participants completed a pretest; website participants also completed a posttest immediately after viewing Infórmate. All participants completed a 3-week telephone follow-up test. Random effects linear regression of 3-week knowledge scores tested the significance of website exposure after adjusting for clustering within families and controlling for pretest scores and covariates.

RESULTS

Two hundred-eighty-two individuals participated (81% patient participation rate). Website exposure was associated with a mean 21.7% same day knowledge score increase between pretest and posttest (P < 0.001). At 3 weeks, website participants' knowledge scores remained 22.6% above the pretest; control scores increased to 11.8% (P = 0.0001). Regression results found that website participants were associated with a 10.0% greater knowledge score at 3-week follow-up (P < 0.0001). Most website participants (92.6%) plan to return to Infórmate in the future.

CONCLUSIONS

Our culturally targeted website increased participants' knowledge about LDKT above and beyond transplant education and should supplement transplant center education for Hispanics. When considered at the population level, Infórmate could have a great impact on knowledge gains in this underserved population disproportionately affected by kidney disease.

Communication partner training for health care professionals in an inpatient rehabilitation setting: A parallel randomised trial

PURPOSE

The purpose of this study is to determine if the E-Learning Plus communication partner training (CPT) programme is as effective as the Supported Conversation for Adults with Aphasia (SCA^TM) CPT programme in improving healthcare professionals' confidence and knowledge communicating with patients with aphasia.

METHOD

Forty-eight healthcare professionals working in inpatient rehabilitation participated. Participants were randomised to one of the CPT programmes. The three outcome measures were self-rating of confidence, self-rating of knowledge and a test of knowledge of aphasia. Measures were taken pre-, immediately post- and 3-4 months post-training. Data were analysed using mixed between within ANOVAs.

RESULT

Homogeneity of variance was adequate for self-rating of confidence and test of knowledge of aphasia data to continue analysis. There was a statistically significant difference in self-rating of confidence and knowledge of aphasia for both interventions across time. No statistically significant difference was found between the two interventions.

CONCLUSION

Both CPT interventions were associated with an increase in health care professionals' confidence and knowledge of aphasia, but neither programme was superior. As the E-Learning Plus CPT programme is more accessible and sustainable in the Australian healthcare context, further work will continue on this CPT programme.

Enhancing Pediatric Trainees' and Students' Knowledge in Providing Care to Transgender Youth

PURPOSE

To enhance pediatric trainees' and students' knowledge of the psychosocial and medical issues facing transgender youth through a comprehensive curriculum.

METHODS

During the 2015-2016 academic year, we administered a transgender youth curriculum to fourth-year medical students, pediatric interns, psychiatry interns, and nurse practitioner students on their 1-month adolescent and young adult medicine rotation. The curriculum included six interactive, online modules and an observational experience in a multidisciplinary pediatric gender clinic. The online modules had a primary care focus with topics of general transgender terminology, taking a gender history, taking a psychosocial history, performing a sensitive physical examination, and formulating an assessment, psychosocial plan, and medical plan. At the completion of the curriculum, learners completed an evaluation that assessed change in perceived awareness and knowledge of transgender-related issues and learner satisfaction with the curriculum.

RESULTS

Twenty learners participated in the curriculum with 100% completing the curriculum evaluations, 100% reporting completing all six online modules, and 90% attending the gender clinic. Learners demonstrated a statistically significant improvement in all pre-post knowledge/awareness measures. On a Likert scale where 5 indicated very satisfied, learners' mean rating of the quality of the curriculum was 4.5 ± .7; quality of the modules was 4.4 ± .7; and satisfaction with the observational experience was 4.5 ± .8.

CONCLUSIONS

A comprehensive curriculum comprised interactive online modules and an observational experience in a pediatric gender clinic was effective at improving pediatric learners' perceived knowledge of the medical and psychosocial issues facing transgender youth. Learners also highly valued the curriculum.

Design and Implementation of a Novel Web-Based E-Learning Tool for Education of Health Professionals on the Antibiotic Vancomycin

Background

Traditional approaches to health professional education are being challenged by increased clinical demands and decreased available time. Web-based e-learning tools offer a convenient and effective method of delivering education, particularly across multiple health care facilities. The effectiveness of this model for health professional education needs to be explored in context.

Objectives

The study aimed to (1) determine health professionals’ experience and knowledge of clinical use of vancomycin, an antibiotic used for treatment of serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and (2) describe the design and implementation of a Web-based e-learning tool created to improve knowledge in this area.

Methods

We conducted a study on the design and implementation of a video-enhanced, Web-based e-learning tool between April 2014 and January 2016. A Web-based survey was developed to determine prior experience and knowledge of vancomycin use among nurses, doctors, and pharmacists. The Vancomycin Interactive (VI) involved a series of video clips interspersed with question and answer scenarios, where a correct response allowed for progression. Dramatic tension and humor were used as tools to engage users. Health professionals’ knowledge of clinical vancomycin use was obtained from website data; qualitative participant feedback was also collected.

Results

From the 577 knowledge survey responses, pharmacists (n=70) answered the greatest number of questions correctly (median score 4/5), followed by doctors (n=271; 3/5) and nurses (n=236; 2/5; P<.001). Survey questions on target trough concentration (75.0%, 433/577) and rate of administration (64.9%, 375/577) were answered most correctly, followed by timing of first level (49%, 283/577), maintenance dose (41.9%, 242/577), and loading dose (38.0%, 219/577). Self-reported “very” and “reasonably” experienced health professionals were also more likely to achieve correct responses. The VI was completed by 163 participants during the study period. The rate of correctly answered VI questions on first attempt was 65% for nurses (n=63), 68% for doctors (n=86), and 82% for pharmacists (n=14; P<.001), reflecting a similar pattern to the knowledge survey. Knowledge gaps were identified for loading dose (39.2% correct on first attempt; 64/163), timing of first trough level (50.3%, 82/163), and subsequent trough levels (47.9%, 78/163). Of the 163 participants, we received qualitative user feedback from 51 participants following completion of the VI. Feedback was predominantly positive with themes of “entertaining,” “engaging,” and “fun” identified; however, there were some technical issues identified relating to accessibility from different operating systems and browsers.

Conclusions

A novel Web-based e-learning tool was successfully developed combining game design principles and humor to improve user engagement. Knowledge gaps were identified that allowed for targeting of future education strategies. The VI provides an innovative model for delivering Web-based education to busy health professionals in different locations.

High engagement, high quality: A guiding framework for developing empirically informed asynchronous e-learning programs for health professional educators

E-learning involves the transfer of skills and knowledge via technology so that learners can access meaningful and authentic educational materials. While learner engagement is important, in the context of healthcare education, pedagogy must not be sacrificed for edu-tainment style instructional design. Consequently, health professional educators need to be competent in the use of current web-based educational technologies so that learners are able to access relevant and engaging e-learning materials without restriction. The increasing popularity of asynchronous e-learning programs developed for use outside of formal education institutions has made this need more relevant. In these contexts, educators must balance design and functionality to deliver relevant, cost-effective, sustainable, and accessible programs that overcome scheduling and geographic barriers for learners. This paper presents 10 guiding design principles and their application in the development of an e-learning program for general practice nurses focused on behavior change. Consideration of these principles will assist educators to develop high quality, pedagogically sound, engaging, and interactive e-learning resources.

Affective capitalism of knowing and the society of search engine

Purpose

The purpose of this paper is to discuss the affective premises and economics of the influence of search engines on knowing and informing in the contemporary society.

Design/methodology/approach

A conceptual discussion of the affective premises and framings of the capitalist economics of knowing is presented.

Findings

The main proposition of this text is that the exploitation of affects is entwined in the competing market and emancipatory discourses and counter-discourses both as intentional interventions, and perhaps even more significantly, as unintentional influences that shape the ways of knowing in the peripheries of the regime that shape cultural constellations of their own. Affective capitalism bounds and frames our ways of knowing in ways that are difficult to anticipate and read even from the context of the regime itself.

Originality/value

In the relatively extensive discussion on the role of affects in the contemporary capitalism, influence of affects on knowing and their relation to search engine use has received little explicit attention so far.

Improved Attitudes to Psychiatry: A Global Mental Health Peer-to-Peer E-Learning Partnership

OBJECTIVE

Health links aim to strengthen healthcare systems in low and middle-income countries through mutual exchange of skills, knowledge, and experience. However, student participation remains limited despite growing educational emphasis upon global health. Medical students continue to report negative attitudes to psychiatry in high-income countries, and in Somaliland, the lack of public sector psychiatrists limits medical students' awareness of mental healthcare. The authors describe the design, implementation, and mixed-methods analysis of a peer-to-peer psychiatry e-learning partnership between UK and Somaliland students arising from a global mental health link between the two countries.

METHODS

Medical students at King's College London and Hargeisa and Amoud universities, Somaliland, were grouped into 24 pairs. Participants aimed to complete ten fortnightly meetings to discuss psychiatry topics via the website MedicineAfrica. Students completed initial and final evaluations including Attitudes toward Psychiatry (ATP-30) questions, a stigma questionnaire, and brief evaluations after each meeting.

RESULTS

Quantitative findings demonstrated that enjoyment, interest, and academic helpfulness were rated highly by students in Somaliland and moderately by students in the UK. Somaliland students' attitudes to psychiatry were significantly more positive post-participation, whereas UK students' attitudes remained stable. Qualitative findings identified more gains in factual knowledge for Somaliland students, whereas UK students reported more cross-cultural learning. Reasons for non-completion and student-suggested improvements emphasized the need to ensure commitment to the program by participants.

CONCLUSIONS

This partnership encouraged students to consider global mental health outside the standard medical education environment, through an e-learning format solely utilizing existing resources. This new approach demonstrates potential benefits to students in contrasting locations of brief, focused online peer-to-peer education partnerships, expanding the scope of health links to the medical professionals of the future.