Mobile spaced education for surgery rotation improves National Board of Medical Examiners scores

The effect of spaced E-Learning on knowledge of basic life support and satisfaction of nursing students: a quasi-experimental study

AIM

Cardiopulmonary resuscitation (CPR) training is essential for all students, especially nursing students. One of the educational approaches to creating long-term learning in inclusive is spaced learning. Spaced learning consists of three or more training sessions in which information is presented over time and at intervals. The present study was conducted to investigate the effect of basic life support (BLS) training through spaced E-learning on the knowledge and satisfaction of nursing students.

METHODS

In this quasi-experimental study with two groups, 106 undergraduate nursing students of Alborz University of Medical Sciences in Iran participated. The control group (n = 47) received BLS training with massed E-learning in one three-hour session, and the intervention group (n = 59) received spaced E-learning in three one-hour sessions. An electronic questionnaire including demographic information and a pre-test of BLS knowledge were sent to both groups. Also, immediately after receiving the training, two weeks later and one month later, they completed a post-test of BLS knowledge. Students were asked to indicate their level of satisfaction with the provided education by completing the SLS-OLE.

RESULTS

The post-test scores immediately after, two weeks later, and one month later of the intervention group were higher than the control group. The results of repeated measurement ANOVA showed that the score changes of knowledge are significant over time (p < 0.001), the number of sessions (p < 0.001), and the interactive effect of them (p < 0.001). There was no statistically significant difference in the level of satisfaction with education in both groups.

CONCLUSION

Based on the results, BLS training in both groups increased the knowledge of BLS. however, the increase in knowledge and its retention was higher in the intervention group that received the training in spaced learning.

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.

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.

Virtual Education in Pediatric Surgery during the COVID-19 Era: Facing and Overcoming Current Challenges

The novel coronavirus disease 2019 (COVID-19) pandemic has impacted our way of living in an unprecedented manner. Medical professionals at all levels have been forced to adapt to the novel virus. The delivery of surgical services and the subsequent learning opportunities for surgical residents have especially been disrupted and the pediatric surgical community has not been exempted by this. This article highlights the challenges imposed by the pandemic and outlines the various learning modalities that can be implemented to ensure continued learning opportunities throughout the pandemic and beyond. Furthermore, it aims to show how the utilization and expansion of technologies maintain and further increase the communication, as well as the exchange of and access to knowledge among peers. Virtual education-, application-, and simulation-based learning and social media, as well as telemedicine and online conferences, will play a considerable role in the future of surgical specialties and surgical education.

Urology at your fingertips: the development of a urology m-learning app for medical students

Background

Surgical education has embraced advancing technology with an emphasis on e-learning in recent years. Smartphones are a useful tool for medical teaching and learning with increasing use by medical students to access e-books, medical calculators, podcasts, and medical applications (apps). Our aim was to develop a dedicated urology app for medical students as an adjunct to traditional teaching.

Methods

We published an e-book: Urology Handbook for Medical Students in 2017 based on the core urology curriculum for medical students. Subsequently, we developed a concise, simple and user-friendly smartphone app for medical students called "Urology Med", available for download on App Store and Google Play.

Results

This app is an introduction to urology for medical students but may also be useful for interns and surgical trainees. The app encompasses core urology topics subdivided into common urological presentations, urological examination, urological diseases, and urological devices. To make the app interactive, it includes 5 clinical cases that complement the reading material and six quizzes for self-assessment. A comprehensive checklist of 31 "must see" and "good to see" urology experiences is included. Within one month of launch, the app was downloaded 435 times in five countries across three continents. It has a 5-star rating on the Apple store.

Conclusions

High educational standards with relevant content make e-learning a valuable learning tool for surgical education. The Urology Med app facilitates easy access to urology and is ideal for quick reading while working or revising.

Use of an Adaptive e-Learning Platform as a Formative Assessment Tool in the Cardiovascular System Course Component of an MBBS Programme

BACKGROUND

Technology-enhanced learning includes the adaptive e-learning platform, a data-driven method with computer algorithms, providing customised learning enhancing critical thinking of individual learners. "Firecracker" - an online adaptive e-learning platform, and assessment software, promotes critical thinking, helps prepare students for courses and high-stakes examinations, and evaluates progress relative to co-learners. The objectives of this study were to determine the usage rates of Firecracker, examine the performance of Firecracker formative quizzes, identify the correlation between Firecracker use and performance with that of performance at summative course assessments, and assess students' satisfaction with Firecracker usage.

METHODS

Study participants were Year-2 MBBS (Bachelor of Medicine, Bachelor of Surgery) students (n=91) of the Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados. The Firecracker Administrator uploaded quizzes covering basic science content in the Cardiovascular System course. Access, usage, and performance on Firecracker formative quizzes were retrieved from the Firecracker dashboard. A questionnaire sought the views of study participants.

RESULTS

Seven sets of quizzes were administered over nine weeks, with weekly student completion rates ranging from 53% to 73%. Mean quiz scores ranged from 52% to 72%. Students completing >4 quiz sessions compared to those completing ≤4 demonstrated significantly better performance in Firecracker quizzes (P<0.01), final examinations (P<0.01) and in-course assessment plus final examination (P<0.05) scores. Correlations between overall Firecracker performance and in-course assessment marks (P<0.05); between total overall Firecracker performance and final examination (P<0.01); and overall Firecracker performance and total course marks (P<0.01) were all significant. Most students (70%) were happy using Firecracker and felt it complemented coursework (78%) and prepared them for course exams (58%) (P<0.01).

CONCLUSION

Overall, Firecracker was perceived very positively and welcomed by the students. Students were satisfied with the Firecracker as a formative assessment tool, and its use correlated with improved performance in the course examinations.

[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.

A modern appraisal of current vascular surgery education

OBJECTIVE

Although general program requirements and curriculum content outlines are provided by the Accreditation Council for Graduate Medical Education, Association for Program Directors in Vascular Surgery, and Vascular Surgery Board of the American Board of Surgery, there is no single format for delivery of this content. The delivery of these defined educational components is, thus, likely to differ from site to site. The curriculum committee of the Association of Program Directors in Vascular Surgery was tasked with formalizing the content of the Vascular Surgery Surgical Council on Resident Education curriculum modules, and, therefore, we sought to appraise the current status of vascular educational programs in U.S. training programs before its implementation.

METHODS

Program directors (PDs) of 112 U.S. vascular surgery residency and fellowship training programs were contacted via email and asked to participate in an anonymous electronic survey. This survey evaluated the educational components of individual programs, including vascular specific conferences, use of other training modalities, and determination of who was involved in the creation of these programs.

RESULTS

Of the 112 PDs offered the survey, 80 (71%) responded. Most (42 of 80; 53%) have both an integrated vascular residency and a fellowship with the remaining being solely fellowship (31 of 80; 39%) or integrated residencies (7 of 80; 9%). The majority (79 of 81; 98%) of programs hold at least one vascular conference per week, with 75% (60 of 81) holding more than one each week. The total time spent in conference averaged 2.6 hours/wk, and the most common educational components of the weekly conferences were review of upcoming (48 of 79, 61%) or recently completed surgical cases (30 of 79; 38%), lectures on vascular disease processes (40 of 79; 51%), and review of book chapters from vascular surgery textbooks (27 of 78; 35%). PDs are responsible for creating the schedule at 50% (39 of 78) of the programs with most remaining programs relying on trainees (18 of 78; 23%) and assistant PDs (17 of 78; 22%). Vascular trainees present the majority of material at most programs' conferences (64 of 77; 83%). The majority of PDs feel that trainees should independently study 4 hours or more per week (51 of 79; 65%), but only 25% (20 of 79) believe that trainees actually spend this amount of time studying (P = .0001). Only 13 of 80 (16%) programs currently use a preformatted standardized vascular curriculum, but 64 of 80 (80%) believe that there is a need for the creation of this product and 72 of 80 (90%) would most likely use it.

CONCLUSIONS

There is a significant variation in vascular surgery educational programs with considerable dependence on trainees to create the curriculum. The majority of PDs in vascular surgery support the creation of a standardized vascular curriculum and would use it if made.

Making a Lecture Stick: the Effect of Spaced Instruction on Knowledge Retention in Medical Education

INTRODUCTION

Poor knowledge retention is a persistent problem among medical students. This challenging issue may be addressed by optimizing frequently used instructional designs, such as lectures. Guided by neuroscientific literature, we designed a spaced learning lecture in which the educator repeats the to-be-learned information using short temporal intervals. We investigated if this modified instructional design could enhance students' retention.

MATERIALS AND METHODS

Second-year medical students (n = 148) were randomly allocated to either the spaced lecture or the traditional lecture. The spaced lecture consisted of three 15-min instructional periods, separated by 5-min intervals. A short summary of the preceding information was provided after each interval. The traditional lecture encompassed the same information including the summary in the massed format, thus without the intervals. All students performed a baseline knowledge test 2 weeks prior to the lectures and students' knowledge retention was assessed 8 days after the lectures.

RESULTS

The average score on the retention test (α = 0.74) was not significantly different between the spaced lecture group (33.8% ± 13.6%) and the traditional lecture group (31.8% ± 12.9%) after controlling for students' baseline-test performance (F(1,104) = 0.566, p = 0.458). Students' narrative comments showed that the spaced lecture format was well-received and subjectively benefitted their attention-span and cognitive engagement.

DISCUSSION AND CONCLUSION

We were unable to show increased knowledge retention after the spaced lecture compared with the traditional lecture. Based on these findings, we provide recommendations for further research. Ultimately, we aim for optimized spaced learning designs to facilitate learning in the medical curriculum and to help educate health professionals with a solid knowledge base.

Conceptualising spaced learning in health professions education: A scoping review

OBJECTIVES

To investigate the definitions and applications of 'spaced learning' and to propose future directions for advancing its study and practice in health professions education.

METHOD

The authors searched five online databases for articles published on spaced learning in health professions education prior to February 2018. Two researchers independently screened articles for eligibility with set inclusion criteria. They extracted and analysed key data using both quantitative and qualitative methods.

RESULTS

Of the 2972 records retrieved, 120 articles were included in the review. More than 90% of these articles were published in the last 10 years. The definition of spaced learning varied widely and was often not theoretically grounded. Spaced learning was applied in distinct contexts, including online learning, simulation training and classroom settings. There was a large variety of spacing formats, ranging from dispersion of information or practice on a single day, to intervals lasting several months. Generally, spaced learning was implemented in practice or testing phases and rarely during teaching.

CONCLUSIONS

Spaced learning is infrequently and poorly defined in the health professions education literature. We propose a comprehensive definition of spaced learning and emphasise that detailed descriptions of spacing formats are needed in future research to facilitate the operationalisation of spaced learning research and practice in health professions education.

Learners and Luddites in the Twenty-first Century: Bringing Evidence-based Education to Anesthesiology

Anesthesiologists are both teachers and learners and alternate between these roles throughout their careers. However, few anesthesiologists have formal training in the methodologies and theories of education. Many anesthesiology educators often teach as they were taught and may not be taking advantage of current evidence in education to guide and optimize the way they teach and learn. This review describes the most up-to-date evidence in education for teaching knowledge, procedural skills, and professionalism. Methods such as active learning, spaced learning, interleaving, retrieval practice, e-learning, experiential learning, and the use of cognitive aids will be described. We made an effort to illustrate the best available evidence supporting educational practices while recognizing the inherent challenges in medical education research. Similar to implementing evidence in clinical practice in an attempt to improve patient outcomes, implementing an evidence-based approach to anesthesiology education may improve learning outcomes.

Bronchoscopy Education: An Experiential Learning Theory Perspective

Bronchoscopy programs implementing the experiential learning model address different learning styles. Problem-based learning improves knowledge retention, critical decision making, and communication. These modalities are preferred by learners and contribute to their engagement, in turn leading to durable learning. Follow-up after live events is warranted through spaced education strategies. The objectives of this article are to (1) summarize and illustrate the implementation of experiential learning theory for bronchoscopy courses, (2) discuss the flipped classroom model and problem-based learning, (3) illustrate bronchoscopy checklists implementation in simulation, and (4) discuss the importance of feedback and spaced learning for bronchoscopy education programs.

Building a CTU Orientation Handbook iPad® application for first-year residents

BACKGROUND

The General Internal Medicine Clinical Teaching Unit (CTU) is a challenging rotation for new residents and the optimal format of orientation has not been determined. We hypothesized that an iPad^® application (app) would be a useful reference tool after residents completed their traditional large group orientation.

METHODS

Postgraduate year 1 (PGY1) residents were sent a link to download the free app one week before the start of their rotation. A pre-usage survey at initial login collected basic demographics. Usage data was collected to determine the sections, duration, and the timeframe from which the app was utilized.

RESULTS

Pre-usage survey data revealed that 63% of participants were female, 69% felt the app would improve orientation, and 94% were comfortable using mobile technology for medical education. Usage data showed "Teaching Sessions and Schedules," "The Consult Note," and "Admission Orders" were the three sections most commonly used. The most usage was during the evening call shift (10pm to 6am), followed by the morning shift (6am to 5pm).

CONCLUSION

The CTU Orientation App was a useful supplement to the traditional orientation. Researchers may not be able to predict what content would be most valuable in an iPad^® app, thus pre-development needs-assessments and usage feedback are crucial.

An mHealth intervention to improve nurses’ atrial fibrillation and anticoagulation knowledge and practice: the EVICOAG study

Background:

There is a need to improve cardiovascular nurses’ knowledge and practices related to stroke prevention, atrial fibrillation and anticoagulation therapy.

Aims:

The aim of this study was to evaluate the efficacy of EVICOAG – a novel mHealth, smartphone-based, spaced-learning intervention on nurses’ knowledge of atrial fibrillation and anticoagulation.

Methods:

Nurses employed in four clinical specialties (neuroscience, stroke, rehabilitation, cardiology) across three hospitals were invited to participate. In this quasi-experimental study, 12 case-based atrial fibrillation and anticoagulation learning scenarios (hosted by an mHealth platform) were delivered to participants’ smartphones over a 6-week period (July–December 2016) using a spaced timing algorithm. Electronic surveys to assess awareness and knowledge were administered pre (T1) and post (T2) intervention.

Results:

From 74 participants recruited to T1, 40 completed T2. There was a 54% mean improvement in knowledge levels post-intervention. The largest improvement was achieved in domains related to medication interaction and stroke and bleeding risk assessment. Post-intervention, those who completed T2 were significantly more likely to use CHA2DS2-VASc (2.5% vs. 37.5%) and HAS-BLED (2.5% vs. 35%) tools to assess stroke and bleeding risk, respectively ( P<0.01).

Conclusion:

The EVICOAG intervention improved nurses’ knowledge of atrial fibrillation and anticoagulation, and influenced their uptake and use of stroke and bleeding risk assessment tools in clinical practice. Future research should focus on whether a similar intervention might improve patient-centred outcomes such as patients’ knowledge of their condition and therapies, medication adherence, time in the therapeutic range and quality of life.

Mobile learning in medicine: an evaluation of attitudes and behaviours of medical students

BACKGROUND

Mobile learning (mLearning) devices (such as tablets and smartphones) are increasingly part of the clinical environment but there is a limited and somewhat conflicting literature regarding the impact of such devices in the clinical learning environment. This study aims to: assess the impact of mLearning devices in the clinical learning environment on medical students' studying habits, attitudes towards mobile device supported learning; and the perceived reaction of clinicians and patients to the use of these devices as part of learning in the clinical setting.

METHODS

Over three consecutive academic years, 18 cohorts of medical students (total n = 275) on a six-week rotation at a large teaching hospital in London were supplied with mLearning devices (iPad mini) to support their placement-based learning. Feedback on their experiences and perceptions was collected via pre- and post-use questionnaires.

RESULTS

The results suggest mLearning devices have a positive effect on the students' perceived efficiency of working, while experience of usage not only confirmed pre-existing positive opinions about devices but also disputed some expected limitations associated with mLearning devices in the clinical workplace. Students were more likely to use devices in 'down-time' than as part of their clinical learning. As anticipated, both by users and from the literature, universal internet access was a major limitation to device use. The results were inconclusive about the student preference for device provision versus supporting a pre-owned device.

CONCLUSION

M-learning devices can have a positive impact on the learning experiences medical students during their clinical attachments. The results supported the feasibility of providing mLearning devices to support learning in the clinical environment. However, universal internet is a fundamental limitation to optimal device utilisation.

Impact of a Non-small Cell Lung Cancer Educational Program for Interdisciplinary Teams

BACKGROUND

Successful implementation of non-small cell lung cancer (NSCLC) evidence-based guideline recommendations requires effective educational programs that target all clinicians from interdisciplinary teams. This study describes and evaluates the Engaging an Interdisciplinary Team for NSCLC (GAIN 3.0) experiential learning-based educational curriculum.

METHODS

GAIN 3.0 was designed to enhance interdisciplinary collaboration for effective NSCLC diagnosis, assessment, and treatment. The program used a flipped classroom model that included an e-learning component prior to a live 6-hour interactive program. The interactive program included hands-on simulations, small group workshops, gamification, and case discussions. Participants included academic and community members of multidisciplinary lung cancer teams. Assessments included an online baseline survey, a pretest and posttest, a program evaluation, a long-term survey (LTS), and on-site faculty evaluation of participants.

RESULTS

Of 416 attendees to 13 live GAIN 3.0 programs (nine in the United States and four in Europe), 304 (73%) completed the pretest and 187 (45%) completed the posttest. Out of a perfect score of 12 points, program participants had a mean test score of 6.3 ± 2.1 on the pretest (52%) and 7.8 ± 2.1 on the posttest (65%) (P = .03). There was an overall knowledge increase of 13% from pretest to posttest. Most LTS respondents (65%) rated the GAIN 3.0 live programs as "high impact." On the LTS, the areas with the greatest gains in participants who had very high confidence were communication across disciplines, use of a team-based approach, and personalized treatment.

CONCLUSIONS

GAIN 3.0 was a highly successful interdisciplinary activity that improved participants' knowledge, competence, and likely the clinical care provided to patients with NSCLC.

Using "big data" to guide implementation of a web and mobile adaptive learning platform for medical students

BACKGROUND

Adaptive learning platforms (ALPs) can revolutionize medical education by making learning more efficient, but their potential has not been realized because students do not use them persistently.

METHODS

We applied educational data mining methods to study United States medical students who used an ALP called Osmosis ( www.osmosis.org ) from 1 August 2014 to 31 July 2015. Multivariate logistic regressions modeled persistence on Osmosis as the dependent variable and Osmosis-collected variables as predictors.

RESULTS

The 6787 students included in our analysis responded to a total of 887,193 items, with 2138 (31.5%) using Osmosis persistently. Number of items per student, mobile device use, subscription payment, and group membership were independently associated with persisting (p < 0.001 in all models). Persistent users rated quality more favorably (p < 0.01) but were not more confident in answer selections (p = 0.80). While persisters were more accurate than non-persisters (55% (SD 18%) vs 52% (SD 22%), p < 0.001), after adjusting for number of items, lower accuracy was associated with persistent use (OR 0.93 [95% CI 0.90-0.97], p < 0.01).

CONCLUSIONS

Our study of a large sample of U.S. medical students illustrates big data medical education research and provides guidance for improving implementation of ALPs and further investigation.

A Team-Based Online Game Improves Blood Glucose Control in Veterans With Type 2 Diabetes: A Randomized Controlled Trial

OBJECTIVE

Rigorous evidence is lacking whether online games can improve patients' longer-term health outcomes. We investigated whether an online team-based game delivering diabetes self-management education (DSME) to patients via e-mail or mobile application (app) can generate longer-term improvements in hemoglobin A_1c (HbA_1c).

RESEARCH DESIGN AND METHODS

Patients (n = 456) on oral diabetes medications with HbA_1c ≥58 mmol/mol were randomly assigned between a DSME game (with a civics booklet) and a civics game (with a DSME booklet). The 6-month games sent two questions twice weekly via e-mail or mobile app. Participants accrued points based on performance, with scores posted on leaderboards. Winning teams and individuals received modest financial rewards. Our primary outcome measure was HbA_1c change over 12 months.

RESULTS

DSME game patients had significantly greater HbA_1c reductions over 12 months than civics game patients (-8 mmol/mol [95% CI -10 to -7] and -5 mmol/mol [95% CI -7 to -3], respectively; P = 0.048). HbA_1c reductions were greater among patients with baseline HbA_1c >75 mmol/mol: -16 mmol/mol [95% CI -21 to -12] and -9 mmol/mol [95% CI -14 to -5] for DSME and civics game patients, respectively; P = 0.031.

CONCLUSIONS

Patients with diabetes who were randomized to an online game delivering DSME demonstrated sustained and meaningful HbA_1c improvements. Among patients with poorly controlled diabetes, the DSME game reduced HbA_1c by a magnitude comparable to starting a new diabetes medication. Online games may be a scalable approach to improve outcomes among geographically dispersed patients with diabetes and other chronic diseases.

Decrease Hospital Spending: There's an App for That! A Retrospective Analysis of Implementation of a Mobile Resident Handbook on Hospital Costs and Disposition

BACKGROUND

Patient care involves time sensitive decisions. Matching a patient's presenting condition with possible diagnoses requires proper assessment and diagnostic tests. Timely access to necessary information leads to improved patient care, better outcomes, and decreased costs.

INTRODUCTION

This study evaluated objective outcomes of the implementation of a novel Resident Handbook Application (RHAP) for smart phones.

METHODS

The RHAP included tools necessary to make proper assessments and to order appropriate tests. The RHAPs effectiveness was accessed using the Military Health System Military Mart database. This database includes patient specific aggregate data, including diagnosis, patient demographics, itemized cost, hospital days, and disposition status. Multivariable analysis was used to compare before and after RHAP implementation, controlling for patient demographics and diagnosis. Internal medicine admission data were used as a control group.

RESULTS

There was a statistically significant decrease in laboratory costs and a strong trend toward statistically significant decreases in the cost of radiology performed after implementation of RHAP (p value of <0.02 and <0.07, respectively). There was also a decrease in hospital days (3.66-3.30 days), in total cost per admission ($18,866-$16,305), and in cost per hospital day per patient ($5,140-$4,936). During the same time period a Control group had no change or increases in these areas.

CONCLUSIONS

The use of the RHAP resulted in decreases in costs in a variety of areas and a decrease in hospital bed days without any apparent negative effect upon patient outcomes or disposition status.