Making Learning Fun: Gaming in Radiology Education

Exploring the experiences of medical students regarding the factors affecting academic achievement: a qualitative study

BACKGROUND

Academic achievement is one of the most important criteria in assessing students' ability to complete their university studies and reach the graduation stage. Students in medical sciences are considered the primary recipients of educational services and are the best source for identifying problems in medical or clinical education, as they are directly and indirectly involved in this interaction process.

METHODS

This study was conducted in the years 2022-2023 using conventional content analysis at Tabriz University of Medical Sciences. A total of 23 students from various faculties of this university were selected through purposive sampling, and their experiences and perspectives were utilized until data saturation was reached. Data was collected through semi-structured, in-depth individual interviews using an interview guide. Content analysis was performed using the conventional content analysis method.

RESULTS

Two main themes were extracted with the titles "Facilitators of Academic Achievement" and "Barriers to Academic Achievement ". "Teacher-related Factors," "Assessment and Evaluation," "Student-related Factors," "Learning Environment," and "Support Systems" were the categories derived from the analysis of the data for academic achievement, and "Poor Educational Quality and Teaching Methods," "Lack of Interdisciplinary Collaboration and Integration," "Inappropriate Educational Planning and Administration," "Communication Issues," and "Contextual barriers," were the categories derived for "Barriers to Academic achievement" based on 238 codes and 36 subcategories.

CONCLUSION

Since factors such as satisfaction with educational and welfare facilities and academic motivation impact the quality of education, examining these variables from students' perspectives is beneficial for formulating regulations, providing appropriate facilities, planning for the training of capable students, and selecting suitable educational and learning processes.

Impact of introducing 3D printing-assisted surgery into clinical practice for traumatic pelvic and acetabular fractures

Background

Given the novelty of three-dimensional (3D) printing-assisted fracture surgery in orthopaedics, surgeon familiarity is limited and learning curve is high. As such, it is unclear how the introduction of 3D printing into clinical practice for pelvic and acetabular fracture surgery would impact perioperative outcomes. The aim of this study was to determine the impact of introducing 3D printing-assisted surgery on perioperative outcomes for traumatic pelvic and acetabular fractures.

Methods

We retrospectively identified consecutive patients who underwent surgical fixation of traumatic pelvic and acetabular fractures from 2018 to 2022 at a single tertiary hospital. The patients included in the study were divided into two groups: (1) 3D printing-assisted surgery and (2) conventional surgery. Baseline demographics and perioperative outcomes of total surgical duration, estimated blood loss, blood transfusion, number fluoroscopy images, fluoroscopy duration and postoperative disposition were recorded and compared between the two groups.

Results

In total, 26 patients were included in the present study, with 3D printing-assisted surgery being used in 34.6 % (n = 9) of cases. There were no significant differences in baseline demographics or fracture type between the 3D printing group and conventional group. As compared to patients who underwent conventional surgery, those that underwent 3D printing-assisted surgery had, on average, shorter surgical duration (299.8 ± 88.2 vs 309.1 ± 143.1 min), lesser estimated blood loss (706.3 ± 330.0 vs 800.0 ± 584.2 ml), lower transfusion rates (50.0 % vs 52.9 %), lower number of intraoperative fluoroscopy images (62.8 ± 74.5 vs 71.6 ± 47.9 images) and shorter fluoroscopy duration (235.0 ± 79.2 vs 242.3 ± 83.5 min), although statistical significance was not achieved. None of the patients in the present study developed surgical complications postoperatively.

Conclusion

The introduction of 3D printing-assisted surgery in clinical practice for pelvic and acetabular fractures is a safe and viable adjunct in pelvic and acetabular surgery, achieving comparable perioperative outcomes in the initial phase.

Student ultrasound education, current view and controversies. Role of Artificial Intelligence, Virtual Reality and telemedicine

The digitization of medicine will play an increasingly significant role in future years. In particular, telemedicine, Virtual Reality (VR) and innovative Artificial Intelligence (AI) systems offer tremendous potential in imaging diagnostics and are expected to shape ultrasound diagnostics and teaching significantly. However, it is crucial to consider the advantages and disadvantages of employing these new technologies and how best to teach and manage their use. This paper provides an overview of telemedicine, VR and AI in student ultrasound education, presenting current perspectives and controversies.

Night and Day, Why Radiologists Need Play

What is play and why does it matter for radiologists? Play can take many forms in the workplace, including organic, managed, task-related, diversionary, and resistive forms of play, and play may also take the form of authentic self-expression and creation. In this review article, we will discuss the benefits of play including improved problem solving, gaining perspective, and stress reduction, and also provide low-tech and high-tech examples of beneficial play for the radiology team in work and personal contexts.

Towards AI-augmented radiology education: a web-based application for perception training in chest X-ray nodule detection

OBJECTIVES

Artificial intelligence (AI)-based applications for augmenting radiological education are underexplored. Prior studies have demonstrated the effectiveness of simulation in radiological perception training. This study aimed to develop and make available a pure web-based application called Perception Trainer for perception training in lung nodule detection in chest X-rays.

METHODS

Based on open-access data, we trained a deep-learning model for lung segmentation in chest X-rays. Subsequently, an algorithm for artificial lung nodule generation was implemented and combined with the segmentation model to allow on-the-fly procedural insertion of lung nodules in chest X-rays. This functionality was integrated into an existing zero-footprint web-based DICOM viewer, and a dynamic HTML page was created to specify case generation parameters.

RESULTS

The result is an easily accessible platform-agnostic web application available at: https://castlemountain.dk/mulrecon/perceptionTrainer.html.The application allows the user to specify the characteristics of lung nodules to be inserted into chest X-rays, and it produces automated feedback regarding nodule detection performance. Generated cases can be shared through a uniform resource locator.

CONCLUSION

We anticipate that the description and availability of our developed solution with open-sourced codes may help facilitate radiological education and stimulate the development of similar AI-augmented educational tools.

ADVANCES IN KNOWLEDGE

A web-based application applying AI-based techniques for radiological perception training was developed. The application demonstrates a novel approach for on-the-fly generation of cases in chest X-ray lung nodule detection employing deep-learning-based segmentation and lung nodule simulation.

Artificial CT images can enhance variation of case images in diagnostic radiology skills training

OBJECTIVES

We sought to investigate if artificial medical images can blend with original ones and whether they adhere to the variable anatomical constraints provided.

METHODS

Artificial images were generated with a generative model trained on publicly available standard and low-dose chest CT images (805 scans; 39,803 2D images), of which 17% contained evidence of pathological formations (lung nodules). The test set (90 scans; 5121 2D images) was used to assess if artificial images (512 × 512 primary and control image sets) blended in with original images, using both quantitative metrics and expert opinion. We further assessed if pathology characteristics in the artificial images can be manipulated.

RESULTS

Primary and control artificial images attained an average objective similarity of 0.78 ± 0.04 (ranging from 0 [entirely dissimilar] to 1[identical]) and 0.76 ± 0.06, respectively. Five radiologists with experience in chest and thoracic imaging provided a subjective measure of image quality; they rated artificial images as 3.13 ± 0.46 (range of 1 [unrealistic] to 4 [almost indistinguishable to the original image]), close to their rating of the original images (3.73 ± 0.31). Radiologists clearly distinguished images in the control sets (2.32 ± 0.48 and 1.07 ± 0.19). In almost a quarter of the scenarios, they were not able to distinguish primary artificial images from the original ones.

CONCLUSION

Artificial images can be generated in a way such that they blend in with original images and adhere to anatomical constraints, which can be manipulated to augment the variability of cases.

CRITICAL RELEVANCE STATEMENT

Artificial medical images can be used to enhance the availability and variety of medical training images by creating new but comparable images that can blend in with original images.

KEY POINTS

• Artificial images, similar to original ones, can be created using generative networks. • Pathological features of artificial images can be adjusted through guiding the network. • Artificial images proved viable to augment the depth and broadening of diagnostic training.

The impact of gamification and potential of kaizen in radiology education

Gamification is an emerging tool in medical education that has been increasingly adopted in the field of radiology. The purpose of this non-systematic review is to explore the use of gamification in medical education with a particular focus on new generations of learners and radiology education. This manuscript begins by examining the effectiveness of gamification in improving learning outcomes in medicine and radiology. Future research recommendations and the potential impact of gamification on new learners are discussed. Finally, this review provides insight into a gaming platform, Kaizen, as a promising approach to enhance education by improving motivation and increasing interest in radiology knowledge.

Gamification: Basic concepts and applications in radiology

Gamification is the use of elements from games in non-game environments, such as education. It is an alternative educational focus that promotes students' motivation and participation in the learning process. Gamification had proven effective in training health professionals and can play an important role in diagnostic radiology training, both at the undergraduate and postgraduate levels. Gamification activities can be carried out in real environments, such as classrooms or session rooms, but there are also interesting online modalities that favor remote access and user management. The possibilities of gamification in virtual worlds to teach undergraduate students radiology are very promising and deserve to be explored in training residents. This article aims to review general concepts in gamification and to present the main types of gamification used in medical training, pointing out its applications and advantages and disadvantages and emphasizing experiences in radiology education.

A Novel Hands-on Approach Towards Teaching Diagnostic Radiology Residents MRI Scanning and Physics

RATIONALE AND OBJECTIVES

Traditional approaches towards teaching magnetic resonance imaging (MRI) scanning and physics have limitations that a hands-on course may help overcome. A dedicated week of MRI instruction may help improve radiology resident confidence and competence. Additional benefits may include improved physician-technologist communication and accelerated mastery of MRI safety.

MATERIALS AND METHODS

Surveys and tests were approved by our Program Evaluation Committee and administered at the beginning and at the end of this one-week course. The course consisted of protected reading time as well as practice scanning with a research magnet and assisting with clinical scanning under the close supervision of a licensed MRI technologist. Eighteen senior residents (nine third-year and nine fourth-year) participated in this course during its first year.

RESULTS

Few residents had previous experience with MRI physics, scanning, or research prior to residency. After this course, mean resident confidence increased by 0.47 points (3.33 vs 2.86; p=0.01) on a five-point Likert scale. Understanding of MRI physics, as measured by pre- and post-tests, increased by 22% (0.72 vs 0.50; p<0.01), corresponding to a large effect size of 1.29 (p<0.001). Resident feedback reported that this course was efficacious (5/5), engaging (4.9/5), and had optimal faculty oversight. The most highly rated component of the course was the opportunity to experiment with the research MR scanner (5/5).

CONCLUSION

A dedicated week of MRI education was highly rated by residents and associated with improvements in confidence and understanding, suggesting a positive correlation between confidence and competence. Additional metrics, such as trends in scores on the American Board of Radiology's Core Examination over the next several years, may further support the apparent benefits of this hands-on MR course.

Radiological education in the era of artificial intelligence: A review

In the era of artificial intelligence (AI), a great deal of attention is being paid to AI in radiological practice. There are a large number of AI products on the radiological market based on X-rays, computed tomography, magnetic resonance imaging, and ultrasound. AI will not only change the way of radiological practice but also the way of radiological education. It is still not clearly defined about the exact role AI will play in radiological practice, but it will certainly be consolidated into radiological education in the foreseeable future. However, there are few literatures that have comprehensively summarized the attitudes, opportunities and challenges that AI can pose in the different training phases of radiologists, from university education to continuing education. Herein, we describe medical students' attitudes towards AI, summarize the role of AI in radiological education, and analyze the challenges that AI can pose in radiological education.

Inaugural Pan-Canadian RADGames: Results From a Successful Approach to Radiology Education for Medical Students

RATIONALE AND OBJECTIVES

A goal in radiology undergraduate medical education is to improve exposure to the field. In 2022, the Canadian Association of Radiologists' Medical Student Network hosted for the first time "RADGames," an interactive image interpretation contest for medical students across Canada. This program was aimed to spark interest in radiology and improve students' image interpretation skills through gamification with expert guidance.

MATERIALS AND METHODS

Volunteers from Radiology Interest Groups in Canadian medical schools set up a virtual event for the competition using breakout rooms and a quiz platform. Participant recruitment was through social media and advertisement by medical student associations. Participants were surveyed anonymously for feedback following the event. Data about previous exposure to and knowledge of radiology, and an evaluation of the event including self-perceived impact on participants' understanding of the field were collected.

RESULTS

Eighty seven medical students from 15 of Canada's 17 medical schools competed against one another virtually. Forty seven (54%) responded to the post-event evaluation survey. All responses about the event itself were favourable. Respondents overwhelmingly indicated that RADGames increased their interest in radiology (38, 81%), their understanding of the work of a radiologist (31, 66%) and their knowledge about medical imaging (46, 98%), and improved their confidence in basic imaging interpretation (36, 77%).

CONCLUSION

The Canadian Association of Radiologists' Medical Student Network hosted Canada's first national image interpretation competition for medical students, RADGames. Feedback was overwhelmingly positive, with perceived benefits to participants on their understanding of and interest in radiology.

The use of technology in postgraduate medical education within radiology: a scoping review

Postgraduate radiology training has traditionally followed didactic approaches; however, complex reasoning skills and critical thinking are essential in the field of radiology. Therefore, the shortages of radiologists in Africa have necessitated the need to review the use of technology in postgraduate education to improve efficient training and service. This scoping review was conducted to map the evidence on the role of technology in postgraduate radiology education and practice. A systematic scoping review search strategy was undertaken to review material published between January 2005 and August 2020 on the use of technology in radiology education. Data from the included studies were extracted and analyzed for emerging themes and presented in response to the research question. Seven articles described studies from the African continent. The most popular technological intervention was telemedicine, and several niche areas of technology implementation were identified (blended learning, flipped learning, digital teaching files). Furthermore, the most challenging aspects relating to technology use remain fiscal and credentialing constraints. Technology plays a role in postgraduate radiology education through networks, synchronous and asynchronous applications. It has the potential to increase support to doctoral students in the African context and alleviate some stressors associated with traditional, face-to-face didactic programs.

Benefits of gamification in medical education

Medical education is changing at a fast pace. Students attend medical school with a high degree of technological literacy and a desire for a diverse educational experience. As a result, a growing number of medical schools are incorporating technology-enhanced active learning and multimedia education tools into their curriculum. Gamified training platforms include educational games, mobile medical apps, and virtual patient scenarios. We provide a systematic review of what is meant by gamification in this era. Specific educational games, mobile apps, and virtual simulations that may be used for preclinical and clinical training have been discovered and classified. The available data were presented in terms of the recognized platforms for medical education's possible benefits. Virtual patient simulations have been shown to enhance learning results in general. Gamification could improve learning, engagement, and cooperation by allowing for real-world application. They may also help with promoting risk-free healthcare decision-making, remote learning, learning analytics, and quick feedback. We account for Preclinical training which included 5 electronic games and 4 mobile apps, while clinical training included 5 electronic games, 10 mobile applications, and 12 virtual patient simulation tools. There were additionally nine more gamified virtual environment training products that were not commercially accessible. Many of these studies have shown that utilizing gamified media in medical education may confer advantages. This collection of hyperlinked resources may be utilized by medical students, practitioners, and instructors at all levels.

Gamification in Radiology Training Module Developed During the Society for Imaging Informatics in Medicine Annual Meeting Hackathon

The purpose of this manuscript is to report our experience in the 2021 SIIM Virtual Hackathon, where we developed a proof-of-concept of a radiology training module with elements of gamification. In the 50 h allotted in the hackathon, we proposed an idea, connected with colleagues from five different countries, and completed an operational proof-of-concept, which was demonstrated live at the hackathon showcase, competing with eight other teams. Our prototype involved participants annotating publicly available chest radiographs of patients with tuberculosis. We showed how we could give experience points to trainees based on annotation precision compared to ground truth radiologists' annotation, ranked in a live leaderboard. We believe that gamification elements could provide an engaging solution for radiology education. Our project was awarded first place out of eight participating hackathon teams.

I.C.A.R.U.S. in Flight: A Radiology Simulator Teaches Imaging Appropriateness, Anatomy, and Image Interpretation Skills

RATIONALE AND OBJECTIVES

The Interactive Clinical Anatomy and Radiology Utilization Simulator (ICARUS) was created in 2012 as a novel simulation program with 25 peer reviewed electronic modules combining simulated patient encounters, American College of Radiology appropriateness criteria, radiologic anatomy, and basic imaging interpretation and patient safety topics. ICARUS integrates a gaming approach to improve student engagement.

MATERIALS AND METHODS

ICARUS modules have been used in the undergraduate medical curriculum at the lead author's institution since its pilot in 2012. Since completion of the full complement of 25 modules, modules have been used in the radiology clerkship (2012- 2015), in the integrated longitudinal curriculum (2015-present), and in various radiology electives (2015-present), including the inaugural virtual radiology electives at all authors' institutions (July 2020-present). Student evaluations were formally solicited in 2014 and again in 2020.

RESULTS

During the introductory radiology clerkship in 2014, 107 students were enrolled. Students were assigned 4 ICARUS modules. During the 2-week virtual elective from July-October 2020, 26 students were enrolled. Students were assigned all 25 modules. The majority of survey respondents "agreed" or "strongly agreed" that the modules were interactive, enjoyable, and self-directed, fostered critical thinking, provided practical value, met goals and objectives of the course, and seemed practical to their future practice.

CONCLUSION

ICARUS integrates key educational concepts in radiology with high fidelity simulation of clinical decision support software and PACS simulation image display to create a highly engaging learning environment that most accurately reflects future clinical experiences.

Are you ready to play Pathology Pyramid? An exploration of an alternative method of learning through gaming in pathology resident education

The pathologists' lexicon is paramount in connecting pathologists, clinicians, and patients. It is an implicit part of pathology diagnoses, and, therefore, a significant component of residency training. We recognize that learning and honing this art is acquired through experience but is also influenced by many factors, such as confidence, familiarity with descriptive terminology, among others. Our project assessed resident views pertaining to their education and perceptions of their descriptive skills. We then introduced Pathology Pyramid (PathPyramid), an educational initiative in a game-style format, which emphasizes communication and supports the goals of strengthening communication in pathology and building confidence. To play PathPyramid, a resident receives a pathology image and describes findings to their team (who do not see the image). The team answers the given prompts related to the image. Pre-game questionnaire was given to trainees to assess perceptions of their abilities in describing pathologic findings. Post-game questionnaire focused on the game's ability to achieve the goals of the activity. Surveys indicate that PathPyramid's strengths lie in building confidence in describing findings in a group and teambuilding. Additionally, variability of responses among trainee sheds light on unseen aspects of individual learning path diversity irrespective of year in training. PathPyramid complements a pathology residency curriculum by helping to erode potential barriers in communication, while fostering comradery.

Using Online Survey Software to Enhance Radiology Learning

RATIONALE AND OBJECTIVES

Online educational modules can augment radiology learning by creating opportunities to interact with images in more dynamic ways than with static presentation of images in lectures or journal articles. Building these modules on an online survey platform allows for quantitative assessment and learner feedback, without requiring programming knowledge or need for new website creation.

MATERIALS AND METHODS

Interactive online tutorials were built on a web-based survey platform (Qualtrics, Provo, Utah) accessible by computer or mobile device to teach radiology imaging findings of selected high-morbidity diagnoses. Topics included congenital-type internal hernias (module 1), acute appendicitis in the pregnant patient (module 2), and unintentionally retained surgical instruments (RSI; module 3). Modules consisted of pretest, educational module, and post-test components. For modules 1 and 2, graphics interchange formats were utilized to show CT and MRI image stacks for the diagnosis of congenital-type internal hernias and acute appendicitis in pregnant patients, respectively. For module 3, the "Heat Map" format was chosen to showcase intraoperative radiograph cases, which allowed participants to click on the potential RSI in the image. Pre- and post-test scores were evaluated. To determine statistical significance, an alpha level of 0.05 was utilized.

RESULTS

Module 1 (Internal Hernia): Twenty-one radiology trainees completed the module. The mean pretest score was 3.66 (±1.13) points out of a total 6 possible points (61%), compared to 4.52 (±1.03) points on the post-test (75%). This was a statistically significant increase on the post-test of 0.87 points (95% CI [confidence interval] 0.36, 1.38), t(20) = 3.53, p= 0.002. Module 2 (MR Appendicitis): Seventeen radiology trainees completed the module. The mean pretest score was 3.18 (±1.42) points out of a total 6 possible points (53%), compared to 5.12 (±0.86) points on the post-test (85%). This was a statistically significant increase on the post-test of 1.94 points (95% CI 1.12, 2.76), t(16) = 5.00, p< 0.001. Module 3 (RSI): One hundred seven participants completed the module. The mean pretest score was 3.60 (±1.53) points out of a total 6 possible points (60%), compared to 4.54 (±1.36) points on the post-test (76%). This was a statistically significant increase on the post-test of 0.94 points (95% CI 0.67, 1.21), t(106) = 6.84, p< 0.001.

CONCLUSION

An online survey platform can be used to build interactive education modules. Post-test scores significantly improved from pretest scores with these educational modules.

Noninterpretive Uses of Artificial Intelligence in Radiology

We deem a computer to exhibit artificial intelligence (AI) when it performs a task that would normally require intelligent action by a human. Much of the recent excitement about AI in the medical literature has revolved around the ability of AI models to recognize anatomy and detect pathology on medical images, sometimes at the level of expert physicians. However, AI can also be used to solve a wide range of noninterpretive problems that are relevant to radiologists and their patients. This review summarizes some of the newer noninterpretive uses of AI in radiology.

An evaluation of undergraduate student nurses' gameful experience while playing an escape room game as part of a community health nursing course

BACKGROUND

The integration of innovative strategies to teaching and learning in higher education, such as escape room games, can enhance the acquisition of key professional competencies including communication, teamwork and critical thinking.

OBJECTIVES

This study aimed to evaluate undergraduate student nurses' gameful experience while playing an escape room game as part of a nursing course.

DESIGN

Cross-sectional descriptive study.

PARTICIPANTS

A total of 126 third year student nurses enrolled in the "Community Health Nursing II" course.

METHOD

The escape room game took place in a classroom at the Faculty of Health Ciences. The measures included the GAMEX scale in its Spanish version and a self-reported questionnaire to evaluate the student's outcome of scape room game immediately after the end of the activity.

RESULTS

The vast majority (99.21%) considered the escape room game to be an appropriate and an innovative teaching and learning strategy. The mean score for each of the GAMEX dimensions was over 3, with the exception of Absence of negative effects. Our results suggest that the students enjoyed playing the game (mean = 4.40; SD = 0.71), that escape room games should be integrated in nursing courses (mean = 4.54; SD = 0.74) and that playing the game increased their motivation for learning (mean = 3.06; SD = 1.09). Gender differences were observed in the GAMEX Dominance dimension (p < 0.005).

CONCLUSION

Gamification in general, and escape rooms in particular, have proven to be a valid tool for the acquisition of professional competencies in higher education.

A team-based competition for undergraduate medical students to learn radiology within the virtual world Second Life

Background

A multi-user competitive game within the virtual world Second Life for undergraduate radiology learning was adapted for team participation. This study aimed to assess student perception, impact on learning, and eventual correlation of game results with post-exposure tests and course grades.

Methods

The game consisted of six weekly stages, dedicated to thoracic, abdominal, and musculoskeletal radiological anatomy and semiology. Participants had several days a week to review self-guided radiology educational content and then complete individual multiple-choice tests and solve team tasks to progress through the game's ranking. Additionally, they completed a cognitive load test, a questionnaire about the experience and a post-exposure knowledge test.

Results

Fifty-two students organised into 13 teams participated in the game and assessed different aspects of the experience with a mean score ≥ 7.8 on a 10-point scale, highlighting the participation of the teacher (9.3 ± 1.1), the educational contents (8.8 ± 1.4) and the usefulness for their education (8.7 ± 1.4). Participants obtained better post-exposure test results (p < 0.007) and better course grades (p < 0.021) than non-participants did.

Conclusion

A multi-user game adapted to team competition to learn radiology in Second Life was very positively perceived by third-year medical students, who highly valued its content, organisation, and usefulness for their training. Most of the participants agreed that they had collaborated as a team and that playing in competitive environments helps them learn better. The best post-exposure and academic results compared to non-participating students indicate the potential impact of the game on learning.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13244-021-01032-3.

Attracting and retaining physicians in less attractive specialties: the role of continuing medical education

BACKGROUND

Less attractive specialties in medicine are struggling to recruit and retain physicians. When properly organized and delivered, continuing medical education (CME) activities that include short courses, coaching in the workplace, and communities of practice might offer a solution to this problem. This position paper discusses how educationalists can create CME activities based on the self-determination theory that increase physicians' intrinsic motivation to work in these specialties.

MAIN CONTENT

The authors propose a set of guidelines for the design of CME activities that offer physicians meaningful training experiences within the limits of the available resources and support. First, to increase physicians' sense of professional relatedness, educationalists must conduct a learner needs assessment, evaluate CME's long-term outcomes in work-based settings, create social learning networks, and involve stakeholders in every step of the CME design and implementation process. Moreover, providing accessible, practical training formats and giving informative performance feedback that authentically connects to learners' working life situation increases physicians' competence and autonomy, so that they can confidently and independently manage the situations in their practice contexts. For each guideline, application methods and instruments are proposed, making use of relevant literature and connecting to the self-determination theory.

CONCLUSIONS

By reducing feelings of professional isolation and reinforcing feelings of competence and autonomy in physicians, CME activities show promise as a strategy to recruit and retain physicians in less attractive specialties.

Measuring the Quality of Clinical Skills Mobile Apps for Student Learning: Systematic Search, Analysis, and Comparison of Two Measurement Scales

BACKGROUND

Mobile apps are widely used in health professions, which increases the need for simple methods to determine the quality of apps. In particular, teachers need the ability to curate high-quality mobile apps for student learning.

OBJECTIVE

This study aims to systematically search for and evaluate the quality of clinical skills mobile apps as learning tools. The quality of apps meeting the specified criteria was evaluated using two measures-the widely used Mobile App Rating Scale (MARS), which measures general app quality, and the Mobile App Rubric for Learning (MARuL), a recently developed instrument that measures the value of apps for student learning-to assess whether MARuL is more effective than MARS in identifying high-quality apps for learning.

METHODS

Two mobile app stores were systematically searched using clinical skills terms commonly found in medical education and apps meeting the criteria identified using an approach based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 9 apps were identified during the screening process. The apps were rated independently by 2 reviewers using MARS and MARuL.

RESULTS

The intraclass correlation coefficients (ICCs) for the 2 raters using MARS and MARuL were the same (MARS ICC [two-way]=0.68; P<.001 and MARuL ICC [two-way]=0.68; P<.001). Of the 9 apps, Geeky Medics-OSCE revision (MARS Android=3.74; MARS iOS=3.68; MARuL Android=75; and MARuL iOS=73) and OSCE PASS: Medical Revision (MARS Android=3.79; MARS iOS=3.71; MARuL Android=69; and MARuL iOS=73) scored highly on both measures of app quality and for both Android and iOS. Both measures also showed agreement for the lowest rated app, Patient Education Institute (MARS Android=2.21; MARS iOS=2.11; MARuL Android=18; and MARuL iOS=21.5), which had the lowest scores in all categories except information (MARS) and professional (MARuL) in both operating systems. MARS and MARuL were both able to differentiate between the highest and lowest quality apps; however, MARuL was better able to differentiate apps based on teaching and learning quality.

CONCLUSIONS

This systematic search and rating of clinical skills apps for learning found that the quality of apps was highly variable. However, 2 apps-Geeky Medics-OSCE revision and OSCE PASS: Medical Revision-rated highly for both versions and with both quality measures. MARS and MARuL showed similar abilities to differentiate the quality of the 9 apps. However, MARuL's incorporation of teaching and learning elements as part of a multidimensional measure of quality may make it more appropriate for use with apps focused on teaching and learning, whereas MARS's more general rating of quality may be more appropriate for health apps targeting a general health audience. Ratings of the 9 apps by both measures also highlighted the variable quality of clinical skills mobile apps for learning.

Are Radiology Educators Using Technology Appropriately?

Technology has allowed for numerous innovations in radiology education. These include, but are not limited to audience response systems, online resources such as YouTube channels, and social media platforms like Twitter. Judicious use of these tools is necessary to best stimulate real-world practice in radiology to optimally educate radiology trainees.

Nurses' Perspectives on Acquiring Play-Based Competence Through an Online Course: A Focus Group Study in Brazil

PURPOSE

The main stage of developing an educational health technology is meeting the expectations of users. Nurses in Brazil can benefit from online training about therapeutic play interventions. This study identified the learning demands of nurses for acquiring competence in the use of therapeutic play to build an online course.

DESIGN AND METHODS

Focus groups study, guided by the COREQ guidelines. Nurses experienced in pediatric care participated in eight groups held in hospitals across all Brazilian regions in 2018. The focus group interviews had a mean duration of two hours and were moderated by the main researcher and an observer, both of whom were nurses experienced in qualitative research. All interviews were audio recorded. The transcripts of the audios were coded, from which the themes were developed, and thematic analysis performed.

RESULTS

Nurses (N = 53, 8.5 ± 6.3 years of experience in pediatric care) reported their learning demands in three themes: "Learning theoretical concepts", "Developing therapeutic play skills", and "Learning the therapeutic play in a fun, interactive and motivational online environment".

CONCLUSION

Nurses learning demands involve theoretical concepts and skills to implement therapeutic play through an interesting online course.

PRACTICE IMPLICATIONS

By developing play-based competence through an online learning environment nurses can feel confident in implementing therapeutic play into their pediatric practice, setting the stage for a future of positive interaction between nurses and children in pediatric health care.

Do Video Games Predict an Early Advanced Capacity to Learn Interventional Radiology Skills?

PURPOSE

To elucidate the relationship between video game (VG) play and interventional radiology (IR) technical skills in medical students.

MATERIALS AND METHODS

Twenty medical students recruited at our institution's IR symposium completed a survey to ascertain demographics and prior VG experience, then participated in a 3-part trial of skills assessing IR and VG skill and visuospatial aptitude (VSA). IR skill was evaluated via an endovascular simulation task, VG skill by performance on three separate VGs, and VSA using the Cube Comparison test. Regression analysis was tested the strength of relationship between IR skill and VG experience, VG skill, and VSA, respectively, and participants were stratified by IR skill to top and bottom halves for survey-response comparison.

RESULTS

There was no correlation between either VG skill or visuospatial aptitude and IR skill (r = -0.22, p = 0.35; and r = 0.14, p = 0.57). Greater number of years playing VGs correlated with superior IR skill (Spearman's rho=-0.45, p<0.05). Students who selected IR as their specialty of interest had extensive VG experience, playing for > 15 years (n = 4, 80%), at least 10 hours per week at their peak (n = 3, 60%), and reported being either "skilled" or "highly skilled" at VGs (n = 3, 60%).

CONCLUSIONS

In our study, though limited by power, number of years playing VGs correlated positively with IR skills in medical students. Prior VG experience may predict an early advanced capacity to learn IR skills and an interest in the specialty.

Role of 3D printing in the management of complex acetabular fractures: a comparative study

PURPOSE

The aim of this study is to assess the role of 3D printing of actual size pelvis in the management and outcome of acetabular fractures.

METHODS

Retrospective study with inclusion of acetabular fractures which were divided into two groups (traditional and 3D printing) was done over a 1 year period. The indices for comparison of both groups in this study were (a) operative time (from skin incision to suture), (b) intraoperative blood loss (noted from the anaesthetist notes), (c) times of intraoperative fluoroscopy, (d) postoperative complications, (e) quality of fracture reduction (good =  < 2 mm displacement, fair =  > 2 mm displacement) and (f) Harris hip score at final follow-up.

RESULTS

27 cases (traditional group = 15, 3D printing group = 12) meeting the study criteria were included in the study with a mean follow-up of 26.3 ± 11.2 months. There was a significant difference in the operative time, intraoperative blood loss and number of intraoperative fluoroscopy images. The mean operative time was shorter in the 3D printing group by 62 min. No difference was noted in the quality of reduction in either of the groups (p > 0.05).

CONCLUSION

3D imaging and printing helps in better understanding of the anatomy of acetabular fractures. It leads to reduced operative time, blood loss as well as exposure to radiation intraoperatively. There is no difference in functional outcome at final follow-up between 3D printing and traditional groups.