Effects of Mobile Learning in Medical Education: A Counterfactual Evaluation

Dental student application of artificial intelligence technology in detecting proximal caries lesions

OBJECTIVES

This study aimed to investigate the caries diagnosis performances of dental students after training with an artificial intelligence (AI) application utilizing deep learning techniques, a type of artificial neural network.

METHODS

A total of 1200 bitewing radiographs were obtained from the institution's database and two specialist dentists labeled the caries lesions in the images. Randomly selected 1000 images were used for training purposes and the remaining 200 radiographs were used to evaluate the caries diagnostic performance of the AI. Then, a convolutional neural network, a deep learning algorithm commonly employed to analyze visual imagery problems, called "You Only Look Once," was modified and trained to detect enamel and dentin caries lesions in the radiographs. Forty dental students were selected voluntarily and randomly divided into two groups. The pre-test results of dental caries diagnosis performances of both groups were recorded. After 1 week, group 2 students were trained using an AI application. Then, the post-test results of both groups were recorded. The labeling duration of the students was also measured and analyzed.

RESULTS

When both groups' pre-test and post-test results were evaluated, a statistically significant improvement was found for all parameters examined except precision score (p < 0.05). However, the trained group's accuracy, sensitivity, specificity, and F1 scores were significantly higher than the non-trained group in terms of post-test scores (p < 0.05). In group 2 (trained group), the post-test labeling time was considerably increased (p < 0.05).

CONCLUSIONS

The students trained by AI showed promising results in detecting caries lesions. The use of AI can also contribute to the clinical education of dental students.

Matching intraoperative teaching and learning for medical undergraduates via modified briefing-intraoperative teaching-debriefing (BID) model

Intraoperative teaching is a challenging task. The briefing-intraoperative teaching-debriefing (BID) model, which is based on guided discovery learning at limited time intervals, has rarely been investigated. This study validated the benefits of the modified BID model on medical clerks. This study involved 37 first-year medical clerks enrolled from September 2019 to May 2020. Every learner scrubbed in one the totally implantable venous access device placement surgery and completed a pre-/posttest survey on surgical procedures and associated anatomy conducted through an intraoperative teaching questionnaire. Of these participants, 15 merely observed throughout the entire procedure (observation group), whereas the remaining 22 performed simple suturing under supervision (suturing group). All participants underwent an objective structured assessment of simple interrupted suturing skills at the end of the observership. Correlations were tested using a two-tailed paired t-test, with a p-value < 0.05 indicating statistical significance. The response rate was 100% and participants could reconfirm the precise venous access, catheter tip location, and suture materials for portal fixation after totally implantable venous access device placement (p < 0.05). Although a relatively higher satisfaction of the intraoperative teaching environment and educator attitude was reported in the suturing group than in the observation group, the difference in scores on the objective structured assessment was not statistically significant (8.7 ± 1.8 vs. 7.2 ± 3.7; p = 0.104). Our findings indicate that the modified BID model with hands-on experience is a practicable module for matching intraoperative teaching and learning via learning perception enhancement for medical undergraduates during totally implantable venous access device placement.

The Effect of Mobile Applied Anatomy Learning on Students' Academic Success, Cognitive Loads, and Attitudes

Purpose/Objectives

Anatomy has always been one of the most important components of Health Science education. Worldwide, anatomy education is given in an environment based on cadaver, touch and 3D designs. However, this process has become quite difficult as the pandemic restricted use of laboratory procedures, models, and other learning materials. Therefore, education with mobile applications has become much more important. The aim of this study was to measure the effect of mobile applications used in anatomy course, which is one of the courses that form the basis of medical science, on the success levels of students, and to evaluate their perspectives on this method.

Methods

In this study, a real experimental research model with pretest-posttest control group was used in order to determine the difference that may occur between academic achievement and cognitive load when anatomy course students use traditional method or mobile application technology learning method.

Results

The findings of the study showed that the students in the experimental group, in which mobile applications were used in the anatomy course, had higher achievement levels and lower cognitive loads than the students in the control group. Another point that was determined was that the students in the experimental group were satisfied with the fact that the use of the mobile application facilitated learning, and they learned better as the ease of use in the mobile application increased.

The outcomes of a mobile just-in-time-learning intervention for teaching bioethics in Pakistan

INTRODUCTION

The study aimed to test the effectiveness and the feasibility of a mobile just-in-time-learning (m-JiTL) approach for teaching bioethics at a university in Pakistan. Over four months, a mobile app (EthAKUL) was used to enhance ethical reasoning among practising nurses, trainee physicians, and medical and nursing students utilising the m-JiTL approach. Participants used EthAKUL to access bioethics modules and participate in asynchronous discussions.

METHODS

A mixed methods design was adopted. Pre- and post-knowledge tests were used to assess changes in participants' knowledge of bioethics concepts, while pre- and post-surveys were used to assess changes in participants' attitudes towards m-learning. After the intervention, focus group discussions with the participants were held. Analysis of the discussion posts and meeting notes was conducted.

RESULTS

The learners had a favourable attitude toward using mobile devices for learning purposes at the start of the intervention, and the score remained positive afterwards. Bioethics knowledge test scores improved at the end of the intervention, with medical students experiencing the greatest improvement. However, because of the high drop-out rate and lack of participation after the initial phase, it is unclear whether the increase in score or positive attitude is the result of the intervention, making it difficult to draw firm conclusions about the intervention's success.

CONCLUSIONS

EthAKUL is the first of its kind app for teaching bioethics, and the study has offered important insights into adopting new pedagogies and technologies for bioethics teaching. It has also identified issues with the design of the app and m-JiTL pedagogy that must be addressed before curriculum-wide adoption.

Mobile applications in medical education: A systematic review and meta-analysis

Objective

This review evaluates the effectiveness of smartphone applications in improving academic performance and clinical practice among healthcare professionals and students.

Methods

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were retrieved from PubMed, Scopus, and Cochrane library through a comprehensive search strategy. Studies that included medical, dental, nursing, allied healthcare professional, undergraduates, postgraduates, and interns from the same disciplines who used mobile applications for their academic learning and/or daily clinical practice were considered.

Results

52 studies with a total of 4057 learner participants were included in this review. 33 studies (15 RCTs, 1 cluster RCT, 7 quasi-experimental studies, 9 interventional cohort studies and 1 cross-sectional study) reported that mobile applications were an effective tool that contributed to a significant improvement in the knowledge level of the participants. The pooled effect of 15 studies with 962 participants showed that the knowledge score improved significantly in the group using mobile applications when compared to the group who did not use mobile applications (SMD = 0.94, 95% CI = 0.57 to1.31, P<0.00001). 19 studies (11 RCTs, 3 quasi-experimental studies and 5 interventional cohort studies) reported that mobile applications were effective in significantly improving skills among the participants.

Conclusion

Mobile applications are effective tools in enhancing knowledge and skills. They can be considered as effective adjunct tools in medical education by considering their low expense, high versatility, reduced dependency on regional or site boundaries, online and offline, simulation, and flexible learning features of mobile apps.

High user acceptance of a retina e-learning app in times of increasing digitalisation of medical training for ophthalmologists

Introduction

The aim was to identify changes in continuing education and training in ophthalmology in the context of the COVID-19 pandemic and advancing digitalization and to analyse the acceptance of e-learning tools among German ophthalmologists using a novel Retina Case App as an example.

Methods

The participants' training behaviour before and during the COVID-19 pandemic was surveyed. Furthermore, the acceptance and usability of the Retina Case App were evaluated using the System Usability Scale (SUS). A possible influence of the app on everyday clinical practice was assessed.

Results

A total of 145 ophthalmologists participated in the survey. The frequency of continuing medical education did not decrease for 62.8% of ophthalmologists during the pandemic. A significant increase in at least monthly use of online courses or lectures has been observed (90.3% vs. 28.2%, p < 0.001). No significant difference was identified in terms of frequency of use of print and digital journals or printed textbooks. The majority of participants stated that online training platforms are well suited to replace the absence of face-to-face events (73.8%). The mean SUS score was 87.7 (SD 11.9), which categorizes the app's usability as excellent. The majority agreed that the newly developed app enables faster learning (82.1%) and leads to increased motivation (71.7%). Most ophthalmologists (80.7%) felt that regular use of the app would improve confidence in the treatment of retinal diseases.

Conclusions

The COVID-19 pandemic has led to a significant change in training behaviour in ophthalmology towards e-learning and online courses, which has not been accompanied by a general decline in training activity. The exemplarily investigated application showed a high user acceptance among ophthalmologists.

Factors Affecting Medical Students’ Continuance Intention to Use Mobile Health Applications

Background

With the dramatic growth in smartphones, mobile health applications (apps) in the field of healthcare or medicine, which are characterized by strong operability, flexibility and interactivity, provide a supplementary approach to medical learning. The aims of this study were to awaken medical students to pay more attention to the learning function of mobile health app and gain deeper insight into our understanding of the factors influencing medical students’ mobile health apps continuance intention for enhancing practical utilization.

Methods

A cross-sectional survey was conducted with a self-designed questionnaire administered to medical students at Chongqing Medical University. Data were collected from 450 participants from March to April 2019. SPSS V.25 was used for the descriptive statistical analysis of the results. Smart PLS 3.2.7 was used to construct a structural equation modelling framework to estimate the influencing factors of medical students’ continuance intention to use mobile health apps.

Results

The external characteristics of mobile health apps had a positive influence on perceived ease of use (β = 0.378, P < 0.001). Perceived ease of use had a positive impact on perceived usefulness (β = 0.573, P < 0.001). Perceived ease of use (β = 0.195, P = 0.011), perceived usefulness (β = 0.450, P < 0.001) and subjective norms (β = 0.255, P < 0.001) had a positive impact on attitude towards using mobile health apps. Additionally, perceived usefulness (β = 0.202, P < 0.001) and attitude (β = 0.730, P < 0.001) had a remarkable influence on continuance intention. Furthermore, the mediating effect of attitude between perceived usefulness and continuance intention was significant (β = 0.329, P < 0.001).

Conclusion

Both perceived usefulness and attitude have a significant effect on medical students’ mobile health apps continuance intention. So, we suggest apps providers and developers evoking and maintaining users’ interest in mobile health apps and perfecting apps’ features from various aspect. Also, more attention should be paid on social relationship to introduce medical students to familiarize mobile health apps and strengthen adhesiveness of medical students.

The Effect of Mobile Learning on Student Success and Anxiety in Teaching Genital System Anatomy

The widespread use of smartphones has led to the emergence of new mobile learning tools. The aim of this study was to compare traditional methods to mobile learning applications, and their effect on the academic achievement and anxiety levels of students learning genital system anatomy. This research study was a randomized controlled study conducted with students who took anatomy between November and December 2018. The cohort consisted of 63 students who met the sampling criteria. Groups (control = 31, experimental = 32) were randomly selected using a simple number table. The mobile application developed for the experimental group was installed on the students' mobile devices with the extension "genitalsystem.apk." The anatomy of the genital system was taught to the control group using the standard curriculum and to the experimental group using the mobile application. After teaching the anatomy of the genital system, the state anxiety levels of the students in the control group were determined to be higher at 45.6 (±8.7) than the experimental group at 40.4 (±8.3) as measured by the 20-80 point STAI scale. The posttest examination average of the control group was 8.9 (±6.9) out of 22 or 40.4 (±6.9)% and the posttest average of the experimental group using mobile application was 14.9 (±5.5) or 67.7 (±5.5)%. State anxiety levels and examination grades showed a highly significant difference in favor of the experimental group. These results indicate that using mobile applications when teaching anatomy may be an effective method to enhance learning and reduce anxiety levels when compared to the traditional teaching methods.

Mobile learning in clinical settings: unveiling the paradox

PURPOSE

The use of mobile devices among medical students and residents to access online material in real-time has become more prevalent. Most literature focused on the technical/functional aspects of mobile use. This study, on the other hands, explored students, doctors and patients' preferences and reasons towards the use of mobile devices in clinical settings underpinned by the Technology Acceptance Model 2 (TAM 2).

METHODS

This research employs an exploratory research design using survey and semi-structured interviews. An online survey was administered to clinical year medical students, followed by semi-structured interviews with the doctors and patients. Questions for the online survey and semi-structured interviews were derived from previous literature and was then reviewed by authors and an expert panel. A convenience sampling was used to invite voluntary participants.

RESULTS

Survey findings showed that most medical students used their devices to find drug information and practice guidelines. The majority of the students accessed UpToDate followed by Google to access medical resources. Key barriers that students often encountered during the use of mobile devices were internet connectivity in the clinical settings, reliability of the information, and technical issues. Thematic analysis of the interviews revealed four themes: general usage by students, receptivity of the use of mobile devices by students, features in selecting resources for mobile learning, and limitation in the current use of mobile devices for learning.

CONCLUSION

The findings from this study assist in recommending suitable material using mobile devices to enhance learning in the clinical environment and expand the TAM 2.

Formative Feedback with In-Class Question Bank Utilization Improves Resident Satisfaction with General Surgery Didactics

BACKGROUND

Formative feedback provides low-stakes opportunities for educational improvement. To enrich our basic science didactics, formative feedback measures were incorporated into our didactics using mobile devices.

MATERIALS AND METHODS

Lecture changes included institutional paid access to a commercial question bank, a 5-item in-class pre-didactic quiz curated from the question bank and taken on the resident's mobile device, and group discussion of quiz topics. An anonymous survey was sent to participating residents.

RESULTS

Overall response rate was 71% among residents. All reported that the new lecture format was a valuable addition to the basic science curriculum (100% Agree/Strongly Agree), and formative assessments provided valuable feedback about the progress of their learning (Strongly Agree = 42%, Agree =58%). All residents reported that in-class use of their mobile device for quizzes was convenient, with majority (84%) preferring it over paper printouts. Residents were more motivated to study before lecture (Strongly Agree = 42%, Agree =42%), with majority also reporting the new format helped identify weaknesses in their knowledgebase (Strongly Agree = 58%, Agree =33%). While majority of residents agreed that quizzes motivated them to study more after lecture, a large portion disagreed (42%). Majority of senior residents reported that the process of composing quizzes prior to lecture enriched their own learning (57%) and helped them find gaps in their knowledge (71%).

CONCLUSION

Incorporating a commercial question bank within didactics gives general surgery residents formative feedback and encourages learning outside the classroom, leading to improved satisfaction with basic science didactics.

Use of a 3D virtual app and academic performance in the study of the anatomy of the musculoskeletal system among Peruvian medical students

Objective

To evaluate the association between the use of a 3D virtual App and academic performance among Peruvian medical students. In addition, factors associated with academic performance were also assessed.

Methods

We conducted an analytical cross-sectional study in students enrolled in the Musculoskeletal System course during the first semester of 2019. Students filled out a data collection form and the “Self-directed learning readiness scale” (SDLRS) questionnaire adapted by Fisher, King, and Tangle. Linear regression models were carried out to assess the association between the appropriate use of the application and academic performance. Additionally, the factors associated with academic performance were evaluated using nested models, and β coefficients were calculated by manual forward selection.

Results

A total of 187 medical students were included. The 61% were female and the median age was 21 [20–22] years. The average grade was 13.5 ± 2 and 21% reported an adequate use of a 3D App. No association was found between the use of the 3D App and academic performance in the adjusted model (aβ = 0.17; 95% CI: -0.45 to 0.80). We found that age (aβ = -0.22; 95% CI: -0.39 to -0.06), performing extracurricular activities (aβ = 0.75, 95% CI: 0.25 to 1.24) and having failed an anatomy/physiology course before (aβ = -2.11 to 95% CI: -2.9 to -1.8) were factors associated with academic performance.

Conclusion

The adequate use of a 3D application to study the anatomy of the musculoskeletal system was not significantly associated with better academic performance.

Exploring Factors of Mobile Device Adoption in Nursing Education

The world has seen an explosion in mobile device technology over the past decade, in addition to the impact that COVID-19 has placed on nursing education programs. More specifically, mobile devices have afforded users with endless possibilities. This upsurge in mobile technology has altered the way people use and interact with their device. One such example is how these devices are being utilized for the purposes of learning due to social distancing guidelines. Thus, it becomes important to explore and understand those factors that will influence the use of mobile devices for learning. The purpose of this study was to explore variables that might influence the adoption of mobile devices among nursing faculty. The Unified Theory of Acceptance and Use of Technology served as the theoretical basis for this study and guiding framework. An exploratory quantitative survey research design was utilized to explore specific variables and their impact on mobile device adoption among participants. It was found that 85%, six of the seven research variables were statistically significant predictors of mobile device adoption. Mobile devices have the potential to leverage a wealth of resources for both users and faculty. Therefore, recommendations for developing increased use of mobile device technology for teaching and learning will be suggested.

Improving dental-oral health learning in students using a mobile application ("My tooth"): A controlled before and after study

OBJECTIVES

Tooth decay is one of the most common problems amongst students. Despite considerable educational interventions, it is still very prevalent. The aim of this study was to compare the effect of a dental-oral health mobile educational application with the common dental-oral health education amongst elementary school students.

METHODS

This interventional study was carried out on 158 girl students in the age range of 10-12 years in Mobarakeh City, Iran. The participants were categorized into the intervention and control groups and investigated in the academic year of 2018-2019. The research tool was a researcher-made questionnaire with confirmed validity and reliability. Initially, all students completed the questionnaires. Later, the intervention group members were trained using dental-oral health mobile educational application and control group received the common dental-oral health educations in lectures and demonstrations. Two months after the last intervention, the same questionnaire was completed and data were analysed by SPSS software.

RESULTS

Before the intervention, the mean score of behaviour was 13.69 ± 3.89 and 13.93 ± 3.02 (of 21) for the intervention and control groups. At this phase, the difference between the two groups was not significant in the studied dimensions (p > 0.05). After the intervention, mean scores of the intervention group increased significantly with regard to all variables (p < 0.05).

CONCLUSIONS

Findings of this study confirmed the positive effect of learning through mobile applications on increasing the students' knowledge, attitude and performance regarding dental-oral health education.

Utility of mobile learning in Electrocardiography

Aims

Mobile learning is attributed to the acquisition of knowledge derived from accessing information on a mobile device. Although increasingly implemented in medical education, research on its utility in Electrocardiography remains sparse. In this study, we explored the effect of mobile learning on the accuracy of electrocardiogram (ECG) analysis and interpretation.

Methods and results

The study comprised 181 participants (77 fourth- and 69 sixth-year medical students, and 35 residents). Participants were randomized to analyse ECGs with a mobile learning strategy [either searching the Internet or using an ECG reference application (app)] or not. For each ECG, they provided their initial diagnosis, key supporting features, and final diagnosis consecutively. Two weeks later, they analysed the same ECGs, without access to any mobile device. ECG interpretation was more accurate when participants used the ECG app (56%), as compared to searching the Internet (50.3%) or neither (43.5%, P = 0.001). Importantly, mobile learning supported participants in revising their initial incorrect ECG diagnosis (ECG app 18.7%, Internet search 13.6%, no mobile device 8.4%, P < 0.001). However, whilst this was true for students, there was no significant difference amongst residents. Internet searches were only useful if participants identified the correct ECG features. The app was beneficial when participants searched by ECG features, but not by diagnosis. Using the ECG reference app required less time than searching the Internet (7:44 ± 4:13 vs. 9:14 ± 4:34, P < 0.001). Mobile learning gains were not sustained after 2 weeks.

Conclusion

Whilst mobile learning contributes to increased ECG diagnostic accuracy, the benefits were not sustained over time.

[Analysis of the importance of e-learning in ophthalmology and evaluation of an e-learning app]

Hintergrund

Ziel der Studie war die Analyse des Stellenwertes von „eLearning“ im Lern- und Fortbildungsverhalten von Augenärzten in Deutschland sowie die Bewertung der Akzeptanz einer neuen „eLearning“-Anwendersoftware (App).

Material und Methoden

Ophthalmologische Weiterbildungsassistenten und Fachärzte wurden im Rahmen von Fortbildungsveranstaltungen mittels eines Fragebogens nach ihren Fortbildungsaktivitäten befragt. Des Weiteren erfolgte nach Vorstellung und Anwendung einer „eLearning-App“ eine strukturierte Bewertung.

Ergebnisse

Es nahmen 149 Augenärzte an der Befragung teil. Während der überwiegende Teil der Kollegen (74,3 %) analoge Fachzeitschriften wöchentlich oder monatlich zur Weiterbildung nutzt, verwenden 45,9 % der Augenärzte digitale Printmedien (Bücher, Zeitschriften, Artikel) sowie 46,5 % Fachbücher in gedruckter Form. Lediglich 35 % der Befragten bilden sich über Online-Fortbildungsplattformen, z. B. digitale Kurse (CME-Kurse) oder Portale zum Abrufen aufgezeichneter Vorträge, fort. Die Nutzung der angebotenen „eLearning-App“ ging insgesamt mit einer positiven Akzeptanz einher; 91,7 % der befragten Kollegen würden diese Form der interaktiven Lernvermittlung weiterempfehlen.

Diskussion

Trotz fortschreitender Digitalisierung in allen Lebensbereichen nimmt „eLearning“ als Lernmedium in der ophthalmologischen Fort- und Weiterbildung weiterhin einen geringen Stellenwert ein. Interessanterweise ergab die Bewertung der App-Nutzer eine hohe Benutzerakzeptanz, unabhängig von Alter oder Arbeitsbereich.

Artificial intelligence-based education assists medical students' interpretation of hip fracture

Background

With recent transformations in medical education, the integration of technology to improve medical students’ abilities has become feasible. Artificial intelligence (AI) has impacted several aspects of healthcare. However, few studies have focused on medical education. We performed an AI-assisted education study and confirmed that AI can accelerate trainees’ medical image learning.

Materials

We developed an AI-based medical image learning system to highlight hip fracture on a plain pelvic film. Thirty medical students were divided into a conventional (CL) group and an AI-assisted learning (AIL) group. In the CL group, the participants received a prelearning test and a postlearning test. In the AIL group, the participants received another test with AI-assisted education before the postlearning test. Then, we analyzed changes in diagnostic accuracy.

Results

The prelearning performance was comparable in both groups. In the CL group, postlearning accuracy (78.66 ± 14.53) was higher than prelearning accuracy (75.86 ± 11.36) with no significant difference (p = .264). The AIL group showed remarkable improvement. The WithAI score (88.87 ± 5.51) was significantly higher than the prelearning score (75.73 ± 10.58, p < 0.01). Moreover, the postlearning score (84.93 ± 14.53) was better than the prelearning score (p < 0.01). The increase in accuracy was significantly higher in the AIL group than in the CL group.

Conclusion

The study demonstrated the viability of AI for augmenting medical education. Integrating AI into medical education requires dynamic collaboration from research, clinical, and educational perspectives.

What is the impact of Apps in medical education? A study of CAPSULE, a case-based learning App

Introduction

Mobile applications (Apps) are popular in medical education; yet, the actual benefits for students are yet to be formally researched. Clinical And Professional Studies Unique Learning Environment (CAPSULE) is an App created by Brighton and Sussex Medical School. The App provides 650 cases offered to students in their final two years of the undergraduate programme. The App performed consistently well in student feedback, and therefore, a study into the educational benefits of the App was constructed.

Methods

A cross-sectional study was performed following two years of use by students to investigate the relationship between App usage and decile ranking.

Results

The study found that the students who completed more cases tended to score higher per case (p value=0.0037). The study also found a trend between having higher case scores and being part of a stronger decile (p value=0.019).

Conclusions

Greater App usage was linked with performing better in the App itself and this was further associated with being in a stronger decile rank. From a user perspective, the data generated from the App could help with identifying students who are underperforming or help students to recognise areas on which they need to focus.

Dispositivos móviles en la educación: tendencias e impacto para la innovación

La innovación es fundamental para el desarrollo de nuevos productos que contribuyan a la generación de valor en la sociedad. Dentro de la educación, la integración de tecnologías de la información y las comunicaciones ha posibilitado la innovación de los procesos de enseñanza-aprendizaje, como es el caso de la utilización de dispositivos móviles (M-Learning) dentro y fuera del salón de clase. En la presente investigación se analiza producción académica sobre la utilización de dispositivos móviles con fines educativos, privilegiando el análisis de las tendencias e impacto. Los principales hallazgos de esta investigación evidencian que la adaptación del M-Learning debe ser una prioridad dado que es la base para el desarrollo de otras estrategias como la realidad aumentada, realidad virtual, realidad mixta, gamificación, laboratorios virtuales y remotos, y la integración de la inteligencia artificial en pro de fortalecer los desafíos del sistema educativo.

Evaluation of e-learning for medical education in low- and middle-income countries: A systematic review

In low- and middle-income countries (LMICs), e-learning for medical education may alleviate the burden of severe health worker shortages and deliver affordable access to high quality medical education. However, diverse challenges in infrastructure and adoption are encountered when implementing e-learning within medical education in particular. Understanding what constitutes successful e-learning is an important first step for determining its effectiveness. The objective of this study was to systematically review e-learning interventions for medical education in LMICs, focusing on their evaluation and assessment methods. Nine databases were searched for publications from January 2007 to June 2017. We included 52 studies with a total of 12,294 participants. Most e-learning interventions were pilot studies (73%), which mainly employed summative assessments of study participants (83%) and evaluated the e-learning intervention with questionnaires (45%). Study designs, evaluation and assessment methods showed considerable variation, as did the study quality, evaluation periods, outcome and effectiveness measures. Included studies mainly utilized subjective measures and custom-built evaluation frameworks, which resulted in both low comparability and poor validity. The majority of studies self-concluded that they had had an effective e-learning intervention, thus indicating potential benefits of e-learning for LMICs. However, MERSQI and NOS ratings revealed the low quality of the studies' evidence for comparability, evaluation instrument validity, study outcomes and participant blinding. Many e-learning interventions were small-scale and conducted as short-termed pilots. More rigorous evaluation methods for e-learning implementations in LMICs are needed to understand the strengths and shortcomings of e-learning for medical education in low-resource contexts. Valid and reliable evaluations are the foundation to guide and improve e-learning interventions, increase their sustainability, alleviate shortages in health care workers and improve the quality of medical care in LMICs.

The Use of a Mobile Learning Tool by Medical Students in Undergraduate Anatomy and its Effects on Assessment Outcomes

Hand-held devices have revolutionized communication and education in the last decade. Consequently, mobile learning (m-learning) has become popular among medical students. Nevertheless, there are relatively few studies assessing students' learning outcomes using m-learning devices. This observational study presents an anatomy m-learning tool (eMed-App), an application developed to accompany an anatomy seminar and support medical students' self-directed learning of the skeletal system. Questionnaire data describe where, how frequently, and why students used the app. Multiple choice examination results were analyzed to evaluate whether usage of the app had an effect on test scores. The eMed-App application was used by 77.5% of the students, mainly accessed by Android smartphones, and at students' homes (62.2%) in order to prepare themselves for seminar sessions (60.8%), or to review learning content (67%). Most commonly, students logged on for less than 15 minutes each time (67.8%). Frequent app users showed better test results on items covering eMed-App learning content. In addition, users also achieved better results on items that were not related to the content of the app and, thus, gained better overall test results and lower failure rates. The top quartile of test performers used the eMed-App more frequently compared to students in lower quartiles. This study demonstrated that many students, especially the high-performing ones, made use of the eMed-App. However, the app itself did not result in better outcomes, suggesting that top students might have been more motivated to use the app than students who were generally weak in anatomy.

Investigating factors affecting on medical sciences students' intention to adopt mobile learning

BACKGROUND

Mobile learning (m-learning) provides a good opportunity for students' lifelong learning. The design and implementation of effective and successful mobile learning requires identification of factors that affect m-learning. The aim of this study was to investigate the factors that affect the intention of students of medical sciences to adopt mobile learning based on theory of planned behavior (TPB).

METHODS

In this cross-sectional study, 332 students of medical sciences were randomly selected. The study tool was a based a questionnaire that had been designed based on TPB model. Descriptive statistics (mean, standard deviation, frequency and percentage) were calculated. In order to determine the standardized factor loading and assess the study hypotheses, structural equation modeling was used. Composite reliability, average variance extracted, and standardized factor loading were used to determine the convergent validity.

RESULTS

The mean of mobile learning readiness was 3.59 ± 0.83. Among the TPB structures, the structures of attitude (β = 0.525) and behavioral control (β = 0.318) had positive and significant effect on the intention to adopt m-learning (P ≤ 0.01). However, the structure of subject norm did not have a significant effect on the intention to adopt m-learning. In general, attitude, behavioral control and subject norm structures were 0.675 determinants of the intention to adopt m-learning (r2 = 0.675).

CONCLUSIONS

In this study Mobile learning readiness of the students was at moderate level. Also the results indicated Positive and significant effect of attitude and behavioral control on the intention of students to accept m-learning. The TPB-based model was a suitable model for identifying psychological factors that affect the intention of students of medical sciences to adopt m-leaning. In order to increase the students' acceptance of mobile learning, we suggest that, other psychological, behavioral, social, and cultural factors that affect the acceptance of m-learning should be identified. Educational programs are also suggested to be introduced to students to familiarize them with the m-learning and its application in learning process.

Development of an application to support in-service training of anesthesiologists on preoperative evaluation in a public hospital in Brazil

RATIONALE, AIMS AND OBJECTIVES

This study investigated the process of construction, use, and field evaluation of a mobile application for teaching in the anesthesiology area.

METHOD

The application was built by using the Co-Design Methodology, which consists of five phases (scoping, shared understanding, brainstorming, refinement and implementation). A one-week case study was carried out in a hospital involving 20 participants (medical students and residents).

RESULTS

The results of the test indicated that the developed application presented a high level of usability.

CONCLUSIONS

The students considered it to be a useful tool for training and systematizing the preoperative evaluation.

Profile of Educational Technology Use by Medical Students and Evaluation of a New Mobile Application Designed for the Study of Human Physiology

Nowadays, smartphones represent an invaluable tool to access educational material; however, the available information is not always accurate or evidence-based. Therefore, we aimed to evaluate the use of technology by medical students and assess the effect of a newly developed mobile app for the study of human physiology. We used a standardised questionnaire to assess the profile of educational technology use, from which a mobile app (PhysioQuiz) was developed. The effectiveness and user opinion were assessed in a randomised controlled study (n = 110). Of 1022 students enrolled in medical school, 489 (47.9%) participated in the study. Of the respondents, 96.7% used mobile applications, with the main purpose being entertainment (94.7%) and study (81.9%). Only 6.1% reported use of physiology apps. PhysioQuiz use did not yield higher average grades (p = 0.48); however, user opinion demonstrated that it was useful for assisted learning (82.1%) and identification of non-learned content (78.6%) and considered a tool for self-assessment (89.3%). Mobile app use is widespread among medical students but there is a lack of human physiology education apps. A newly developed app for the study of human physiology was useful for assisted learning and considered a tool for self-assessment.

Mobile learning in dentistry: usage habits, attitudes and perceptions of undergraduate students

Introduction

The aim of this study was to evaluate usage habits, attitudes and perceptions towards mobile learning (m-learning), as well as to identify variables related to those attitudes amongst undergraduate dental students.

Materials and Methods

The study consists of 81 dental undergraduate students who who volunteered to participate. The data collection tool consists of an m-learning attitude scale, a questionnaire, and open-ended questions. To compare the total scores and factors of m-learning attitude scale for demographic information and mobile technology usage habits of the students; the Mann-Whitney U test was used for two independent groups such as gender, presence of electronic devices, and places of Internet usage. The Kruskal-Wallis test was also used to compare the total scores and factors of m-learning attitude scale for more than two independent groups including internet usage purposes and opinions. Spearman's correlation coefficient was performed, and linear regression analysis was used to predict the change in total score according to the purposes of Internet usage.

Results

The majority of students thought that the use of mobile devices in dentistry courses was useful and their attitudes towards m-learning were high. The students generally use the Internet for online shopping, connecting to social networks, and communication. They tend to use mobile technologies for personal use, followed by educational purposes. There were significant differences found in the m-learning attitudes for gender, having a portable power supply and use of mobile devices in dentistry courses. Communication was found significant in predicting the change in total score for the m-learning attitude scale according to the purpose of Internet usage.

Conclusion

Dental students have generally positive attitudes towards m-learning. Students raise awareness towards the promise of m-learning in order to apply their individual technology use and learning behaviours. Designing learning materials and applications for mobile devices may increase students' performances.

Preferences of the medical faculty members for electronic faculty development programs (e-FDP): a qualitative study

INTRODUCTION

Medical faculties are responsible for the training and development of future physicians. Therefore, they must learn the teaching methods. Considering their extensive roles, adult learning theory, and technological developments, the best solution is e-learning. This study extracted the views and preferences of clinical faculties about the electronic faculty development programs.

METHODS

Clinical faculty members and medical education and e-learning specialists from medical universities in Iran participated in this qualitative content analysis study during 2017-2018. Data were collected with purposive sampling method by 18 semi-structured interviews and 2 focus groups with 11 participants. The data were analyzed using the conventional qualitative content analysis method. Validity and accuracy of data were provided on the basis of Guba and Lincoln criteria.

RESULTS

Five categories including "Technology infrastructure" (Presentation, Platform, E-Learning environment), "learner" (Features, Motivation), "Program management" (Blending, Interaction), "content" (Design, Application, Organization), and "evaluation" (Learner assessment, Program evaluation) were extracted.

CONCLUSION

Faculty members prefer to attend e-learning courses that focus on individualization, blended learning, and mobile learning. The best solution is to use the microlearning approach, that is, short pieces of content focusing on a learning goal that can be presented by all electronic devices in the form of any kind of media, and is in fact the learning fingerfood.

Developing the Evidence Base for M-Learning in Undergraduate Radiology Education: Identifying Learner Preferences for Mobile Apps

PURPOSE

There is a lack of evidence for developing radiology mobile apps for medical students. This study identifies the characteristics which students perceive as most valuable to teaching radiology with mobile apps (m-learning).

METHODS

An online anonymous survey was administered to second- to fourth-year medical students at a single institution. The survey, which was based on established theoretical framework, collected students' preferred content organization, content presentation, and delivery strategies. The Copeland method was used to rank student preferences and a 2-tailed t test was used to determine if student responses were related to their clinical experience, with statistical significance at P < .05.

RESULTS

The response rate was 25.6% (163/635). For content organization, image interpretation (66.9%), imaging anatomy (61.3%), and common pathological conditions (50.3%) were selected as the most important. For content presentation, quizzes (49.1%) and case presentations (46.0%) were selected as the most useful. Students with clinical experience rated algorithms as more important (P < .01) and quizzes as less important (P = .03). For delivery strategies, ease of use (92.6%), navigation (90.8%), and gestural design (74.8%) were deemed the most applicable.

CONCLUSION

This study documents medical students' preferences for m-learning in radiology. Although learner preferences are not the only feature to consider in the development of educational technology, these provide the initial framework for radiologists wishing to develop and incorporate mobile apps into their teaching.

A skills acquisition study on ECMOjo: a screen-based simulator for extracorporeal membrane oxygenation

BACKGROUND

Extracorporeal membrane oxygenation relies heavily on didactic teaching, emphasizing on essential cognitive skills, but overlooking core behavioral skills such as leadership and communication. Therefore, simulation-based training has been adopted to instill clinical knowledge through immersive experiences. Despite simulation-based training's effectiveness, training opportunities are lessened due to high costs. This is where screen-based simulators come into the scene as affordable and realistic alternatives.

AIM

This article evaluates the educational efficacy of ECMOjo, an open-source screen-based extracorporeal membrane oxygenation simulator that aims to replace extracorporeal membrane oxygenation didactic instruction in an interactive and cost-effective manner.

METHOD

A prospective cohort skills acquisition study was carried out. A total of 44 participants were pre-assessed, divided into two groups, where the first group received traditional didactic teaching, and the second used ECMOjo. Participants were then evaluated through a wet lab assessment and two questionnaires.

RESULTS

The obtained results indicate that the two assessed groups show no statistically significant differences in knowledge and efficacy. Hence, ECMOjo is considered an alternative to didactic teaching as per the learning outcomes.

CONCLUSION

The present findings show no significant dissimilarities between ECMOjo and didactic classroom-based teaching. Both methods are very comparable in terms of the learner's reported self-efficacy and complementary to mannequin-based simulations.

Mobile Learning in Medical Education

Currently, mobile learning is a new trend in medical education. Therefore, the aim of this study is to examine the use of m-learning in medical education and discuss its effect on student learning process in order to help future medical professionals deliver better care for patients and populations. This was done by conducting a literature search in the databases Web of Science, Scopus, and MEDLINE, and consequently by evaluating the findings of the selected studies. The results of this study confirm that mobile learning is efficient, especially in the acquisition of new knowledge and skills. Nevertheless, so far, the role of mobile learning has been perceived as an appropriate complement to traditional learning. Therefore, more research should be conducted on the efficacy of the use mobile learning in medical education, as well as to explore the unique features of mobile devices for the enhancement of learning outcomes.

Validation of the educational effectiveness of a mobile learning app to improve knowledge about MR image quality optimisation and artefact reduction

Aim

The aim was to design an app-based eLearning tool to provide radiographers with information about the physical basis of MR artefacts and practical elimination or/and minimisation strategies to optimise image quality, and to evaluate the impact of a smartphone app on radiographers’ knowledge.

Methods

The study used the comparison-experimental approach (pre- and post-test). Thirty-five MR radiographers independently reviewed a prepared series of MR images (n = 25). The participants were requested to identify image quality related errors, to specify error-correction strategies and to score how confident they were in their responses. Participants were then divided into experimental (n = 19) and control cohorts (n = 16). The app was provided to the experimental cohort for 3 months; after this period both cohorts re-reviewed the MR image datasets and repeated their identification of image quality errors.

Results

The results showed a statistically significant difference between control and experimental cohorts relative to participants’ pre- to post-test knowledge level. For the experimental cohort, years of experience, qualification and type of hospital were not associated with radiographer knowledge level and confidence in recognising the presence of an image quality error, naming the error and specifying appropriate correction strategies (p > 0.05).

Conclusion

The study identified the potential of the smartphone app as an effective educational tool to support MR radiographers’ knowledge in recognising and characterising MR image quality errors.

Key Points

• A high level of knowledge to optimise MR image quality is crucial.

• Ongoing education in image quality optimisation is required.

• The potential role of app as an effective educational tool is identified.

The Self-Perception and Usage of Medical Apps amongst Medical Students in the United States: A Cross-Sectional Survey

Background. Mobile medical software applications (apps) are used for clinical decision-making at the point of care. Objectives. To determine (1) the usage, reliability, and popularity of mobile medical apps and (2) medical students' perceptions of app usage effect on the quality of patient-provider interaction in healthcare settings. Methods. An anonymous web-based survey was distributed to medical students. Frequency of use, type of app used, and perceptions of reliability were assessed via univariate analysis. Results. Seven hundred thirty-one medical students responded, equating to a response rate of 29%. The majority (90%) of participants thought that medical apps enhance clinical knowledge, and 61% said that medical apps are as reliable as textbooks. While students thought that medical apps save time, improve the care of their patients, and improve diagnostic accuracy, 53% of participants believed that mobile device use in front of colleagues and patients makes one appear less competent. Conclusion. While medical students believe in the utility and reliability of medical apps, they were hesitant to use them out of fear of appearing less engaged. Higher levels of training correlated with a greater degree of comfort when using medical apps in front of patients.