Internet-based learning and applications for critical care medicine

Perception of E-Resources on the Learning Process among Students in the College of Health Sciences in King Saud University, Saudi Arabia, during the (COVID-19) Outbreak

Aim: to assess the impact of e-learning through different e-resources among health sciences students. Methodology: A cross-sectional design was conducted among health science students (n = 211; 134 female and 77 male) at King Saud University, Saudi Arabia. The data was collected using a previously used structured questionnaire to assess the impact of e-resources on learning. Results: The four most frequently used e-resources were: Zoom (38%), YouTube (31%), Google applications (29%), and Blackboard (27%). More than one-third of the students (35%) reportedly used e-resources for three or more hours daily. The majority of the students (55.9%) recognized a gender-related and age-related difference among faculty members in terms of e-resources usage. The majority of the students (58.2%) believe that online resources recommended by faculty members were credible. The majority of students believed that their academic performance was primarily influenced by these features of the e-resources: organization/logic of the content (64.5%), the credibility of the video (64.5%), and up to date “look and feel” of the video (60.6%). The study identified the most frequently used e-resources, gender, and age-related differences in faculty members’ use of e-resources, students’ overwhelming reliance on faculty feedback regarding the credibility of e-resources, and three most important characteristics (organization, credibility, and updated status) of e-resources. Conclusion: e-learning resources had a significant impact on participating students’ education as they were used very frequently during their health sciences’ courses.

Difference in postcourse knowledge and confidence between Web-based and on-site training courses on resuscitative endovascular balloon occlusion of the aorta

Aim

Effective courses are essential for highly invasive procedures such as resuscitative endovascular balloon occlusion of the aorta. However, the coronavirus disease pandemic has forced the postponement of on‐site educational courses due to transmission concerns. Few studies have examined the effectiveness of Web‐based education in highly invasive procedures. To address this knowledge gap, this study aimed to investigate whether knowledge acquisition and confidence after the Web‐based course are different from those acquired after the on‐site course, using pre‐ and postcourse test scores.

Methods

The increase in scores before and after the course was compared between the on‐site and Web‐based courses. The questions reflected knowledge about seven different topics in the course modules. In addition, participants were asked about their self‐rated confidence about three topics before and after the course.

Results

Thirty learners completed the on‐site course, and 21 learners completed the Web‐based course. Forty‐seven learners completed both the precourse and postcourse tests. In both courses, the difference between the precourse and postcourse test scores showed a statistically significant increase in knowledge (on‐site course: increased score, 1.8; 95% confidence interval, 0.8 to 2.8; Web‐based course: increased score, 1.6, 95% confidence interval, 0.5 to 2.5). However, the difference was not statistically significant in the self‐rated confidence scores about “sheath and catheter removal” among learners of the Web‐based course.

Conclusion

Knowledge increased significantly in both the on‐site and Web‐based courses. However, the Web‐based course might not be sufficient to give learners confidence in the procedures.

E-learning versus face-to-face training: Comparison of two learning methods for Lyme borreliosis

OBJECTIVES

To compare two learning methods for Lyme disease (e-learning versus face-to-face training) to assess knowledge and know-how.

METHODS

The study population was volunteer general medicine residents and family physicians (FP). Face-to-face training on Lyme disease was offered to each group. E-learning training was then offered to those who had not attended the face-to-face training. Theoretical knowledge was assessed by an identical pre- and post-test questionnaire and know-how by a script concordance test.

RESULTS

Seventy learners (47 FPs and 23 general medicine residents) were included in the face-to-face training group and 61 (33 FPs and 28 general medicine residents) in the e-learning group. The pre- and post-test scores were significantly improved in the FP group (difference of 29.3±1.9 [P<0.0001] out of 100) as well as in the general medicine resident group (difference of 38.2±2.7 [P<0.0001] out of 100). E-learning was more effective than face-to-face training, particularly among general medicine residents (progression of mean difference of 44.3±3.4/100 vs. 30.9±4.0/100; P=0.0138) and to a lesser extent among FPs (progression of 25.3±2.3/100 vs. 31.9±2.7/100; P=0.0757). Forty-six script concordance tests were completed by FPs and 20 by general medicine residents. Script concordance test results did not seem significant between the subgroups.

CONCLUSIONS

E-learning seems to be a good alternative to face-to-face training for Lyme disease. It seems to be more effective than face-to-face training for the acquisition of theoretical knowledge. The script concordance test evaluation of know-how did not show any difference between the two learning methods.

An exploration of student access to a learning management system-challenges and recommendations for educators and researchers

INTRODUCTION

This study examined student access to online resources of a faculty's learning management system (LMS). Issues relating to current e-learning resources usage were identified and formed the basis for recommendations to help assist stakeholders in teaching, learning and research.

METHODS

Learning analytics from four cohorts of undergraduate dental students were extracted from the database of a LMS spanning between 2012 and 2016. Individual datasets were combined into one master file, re-categorised, filtered and analysed based on cohort, year of study, course and nature of online resource.

RESULTS

A total of 157,293 access events were documented. The proportion of administrative to learning data varied across cohorts, with oldest cohort having the highest ratio (82:18) in their final year and most recent cohort having a ratio of 33:67 in their 4th year demonstrating a higher proportion to learning. Seven Learning domains were identified in the access data: access to problem-based learning resources was the highest and next was fixed prosthodontics videos. The prosthodontics discipline had the highest access across the curriculum while some others had very limited or even no learning access events.

CONCLUSION

A number of limitations have been identified with the analytics and learning resources in this LMS and engagement with learning resource provision. More detailed data capture of access use and unique identifiers to resources as well as keyword tagging of the resources are required to allow accurate mapping and support of students learning. Moreover, motivation or nudging of students behaviour to more actively engage with learning content needs exploration.

The relation of online learning analytics, approaches to learning and academic achievement in a clinical skills course

INTRODUCTION

This study examined relationships of students' access of e-learning (learning analytics) for a healthcare psychomotor skills course, approaches to learning (R-SPQ-2F psychometric) and academic achievement (summative examination results). An understanding of the relationships may help in supporting students learning.

METHODS

Two consecutive cohorts of 5th year dental students were asked to complete the R-SPQ-2F questionnaire and permission to access data of online videos and associated quizzes and two summative written examination results were examined. The summative assessments were an OSCA and a written-paper question both in prosthodontics. Multiple linear regression and correlation analysis were performed.

RESULTS

Students (n=98) performed a total of 10470 video access events and 7714 attempts in online quizzes. Deep learning approach was the strongest predictor variable (β=0.270; P=.004) on written-paper question result. While video and quiz access were moderately correlated (r=0.600; P<.001) to each other, video access was not a significant predictor to either of the examination results. Quiz access was negatively associated with academic achievement for the written-paper question results (β=-0.349; P<.001).

CONCLUSIONS

Only deep approach to learning appeared to be relevant for the written-paper question examination grades. Conversely, the number of video and quiz access did not relate to either examination results. This suggests e-learning access and examinations do not appear to relate under the conditions explored. Other attributes of learning management access may need to be explored to determine if access to learning management systems may be useful in offering remedial support to students.

A Risk Assessment Framework Proposal Based on Bow-Tie Analysis for Medical Image Diagnosis Sharing within Telemedicine

The purpose of this paper is to propose a framework for cybersecurity risk management in telemedicine. The framework, which uses a bow-tie approach for medical image diagnosis sharing, allows the identification, analysis, and assessment of risks, considering the ISO/TS 13131:2014 recommendations. The bow-tie method combines fault tree analysis (FTA) and event tree analysis (ETA). The literature review supported the identification of the main causes and forms of control associated with cybersecurity risks in telemedicine. The main finding of this paper is that it is possible, through a structured model, to manage risks and avoid losses for everyone involved in the process of exchanging medical image information through telemedicine services. Through the framework, those responsible for the telemedicine services can identify potential risks in cybersecurity and act preventively, recognizing the causes even as, in a mitigating way, identifying viable controls and prioritizing investments. Despite the existence of many studies on cybersecurity, the paper provides theoretical contributions to studies on cybersecurity risks and features a new methodological approach, which incorporates both causes and consequences of the incident scenario.

Flipped classroom in the second decade of the Millenia: a Bibliometrics analysis with Lotka's law

This paper aims to examine the current dynamics of the flipped classroom studies and to propose a direction for future research for the field. Using a bibliometric approach, we observe a sample of 1557 documents from the Scopus database to identify research activity on the flipped classroom. The keywords "flipped classroom" and "flipped learning" have been executed in the search query. We presented the earlier stage of research in the flipped classroom, the subsequent trends, publications status based on source title, country and institution and examined citations pattern of the publication. We also discuss the themes based on the occurrences and terms of the keywords, title and abstract of the documents. This paper also predicts the future study in the flipped classroom using Lotka's law. We found that the pattern distribution of the author's contribution fits with the law. We conclude by suggesting a few potential research directions on the flipped classroom. Research on flipped classroom focuses on approaches, strategies and effectiveness perceived by practitioners and learners with relatively less attention on author's contribution and the prediction on their future and sustainable contribution and networking in guaranteeing the survival and expansion of flipped classroom approach for the coming decades.

[Hospital paramedic. An interprofessional blended learning concept to qualify paramedics and medical personnel for deployment in intensive care units and emergency departments during the COVID-19 pandemic]

Hintergrund

Die COVID-19-Pandemie machte eine zeitkritische Erweiterung der personellen Intensiv- und Notaufnahmekapazitäten notwendig.

Ziel der Arbeit

Diese Arbeit schildert erste Ergebnisse eines Blended-Learning-Konzepts zur Qualifikation von Rettungsdienst- und medizinischem Personal in intensivmedizinischen Maßnahmen zur Zeit der COVID-19-Pandemie.

Material und Methoden

Interprofessionell erfolgte die Entwicklung und Umsetzung eines 2‑stufigen Blended-Learning-Konzepts (Stufe 1: E‑Learning mit Onlinetutorials, Stufe 2: Praxiseinsatz) in 3 Modulen (Intensivstation, Notaufnahme, innerklinische Notfallmedizin) zur Weiterqualifikation in intensivmedizinischen und -pflegerischen Maßnahmen. Erfasst wurden Einsatzort, durchgeführte Maßnahmen, subjektive Kenntnisstandbewertung der definierten Maßnahmen vor und nach Abschluss der Weiterqualifikation anhand einer 4‑stufigen Likert-Skala, Bewertung der Einsetzbarkeit im Rahmen der COVID-19-Pandemie sowohl durch die Teilnehmenden als auch Praxisanleitenden bzw. supervidierenden Ärzte.

Ergebnisse

Nach 6 Wochen hatten 63 % der 92 angemeldeten Teilnehmenden den Onlinekurs und 29 % zusätzlich ihren Praxiseinsatz (Intensivstation bzw. Notaufnahme) abgeschlossen. Auf Intensivstationen assistierten sie u. a. bei der Vorbereitung von Katheteranlagen, Medikamenten, pflegerischen Tätigkeiten, in Notaufnahmen bei der Triage und der Erstversorgung. Nach Abschluss fühlten sich die Kliniksanitäter signifikant sicherer bei einem Krankenhauseinsatz, der Assistenz der ZVK-Anlage sowie der Tracheostomapflege (p < 0,05). Alle Teilnehmenden willigten ein, im Rahmen der COVID-19-Pandemie zu unterstützen. Die Praxisanleitungen bewerteten die Teilnehmenden in 94 % als einsetzbar.

Diskussion

Blended-Learning-Konzepte können zeitkritisch medizinisch vorgebildetes Personal für den Einsatz in kritischen Krankenhausbereichen qualifizieren, Pflegekräfte entlasten und für eine personelle Erweiterung der Intensivkapazitäten freisetzen. Die aktuellen Empfehlungen und zukünftigen Pandemiepläne sollten diesbezüglich erweitert werden.

Learning without Borders: Asynchronous and Distance Learning in the Age of COVID-19 and Beyond

The coronavirus disease (COVID-19) pandemic has disrupted not only clinical care but also medical education. Physical distancing and shift rearrangements for both trainees and faculty have led to abrupt cancelation of many in-person didactics. These have been replaced by distance learning options, which include both synchronous and asynchronous curricula. Unfortunately, many medical educators have been forced to quickly create distance-learning options for trainees with little prior experience. In this perspective, we review the evidence base for distance learning and discuss practical considerations for transitioning traditional in-person curricula to distance platforms. We review technical aspects of distance learning as well as educational principles essential for success. The goal is for medical educators to optimize distance learning not just during this COVID-19 pandemic but beyond this crisis as well.

The Top Ten Websites in Critical Care Medicine Education Today

INTRODUCTION:

The number of websites for the critical care provider is rapidly growing, including websites that are part of the Free Open Access Med(ical ed)ucation (FOAM) movement. With this rapidly expanding number of websites, critical appraisal is needed to identify quality websites. The last major review of critical care websites was published in 2011, and thus a new review of the websites relevant to the critical care clinician is necessary.

METHODS:

A new assessment tool for evaluating critical care medicine education websites, the Critical Care Medical Education Website Quality Evaluation Tool (CCMEWQET), was modified from existing tools. A PubMed and Startpage search from 2007 to 2017 was conducted to identify websites relevant to critical care medicine education. These websites were scored based on the CCMEWQET.

RESULTS:

Ninety-seven websites relevant for critical care medicine education were identified and scored, and the top ten websites were described in detail. Common types of resources available on these websites included blog posts, podcasts, videos, online journal clubs, and interactive components such as quizzes. Almost one quarter of websites (n = 22) classified themselves as FOAM websites. The top ten websites most often included an editorial process, high-quality and appropriately attributed graphics and multimedia, scored much higher for comprehensiveness and ease of access, and included opportunities for interactive learning.

CONCLUSION:

Many excellent online resources for critical care medicine education currently exist, and the number is likely to continue to increase. Opportunities for improvement in many websites include more active engagement of learners, upgrading navigation abilities, incorporating an editorial process, and providing appropriate attribution for graphics and media.

Children With Medical Complexity: A Web-Based Multimedia Curriculum Assessing Pediatric Residents Across North America

OBJECTIVE

No standardized curricula exist for training residents in the special needs of children with medical complexity. We assessed resident satisfaction, knowledge, and behavior after implementing a novel online curriculum composed of multimedia modules on care of children with medical complexity utilizing virtual simulation.

METHODS

We conducted a randomized controlled trial of residents across North America. A Web-based curriculum of 6 self-paced, interactive, multimedia modules was developed. Readings for each topic served as the control curriculum. Residents were randomized to 1 of 2 groups, each completing 3 modules and 3 sets of readings that were mutually exclusive. Outcomes included resident scores on satisfaction, knowledge-based assessments, and virtual simulation activities.

RESULTS

Four hundred forty-two residents from 56 training programs enrolled in the curriculum, 229 of whom completed it and were included in the analysis. Subjects were more likely to report comfort with all topics if they reviewed modules compared to readings (P ≤ .01 for all 6 topics). Posttest knowledge scores were significantly higher than pretest scores overall (mean increase in score 17.7%; 95% confidence interval 16.0, 19.4), and the mean pre-post score increase for modules was significantly higher than readings (20.9% vs 15.4%, P < .001). Mean scores on the verbal handoff virtual simulation increased by 1.1 points (95% confidence interval 0.2, 2.0, P = .02). There were no significant differences found in pre-post performance for the device-related emergency virtual simulation.

CONCLUSIONS

There was high satisfaction, significant knowledge acquisition, and specific behavior change after participating in this innovative online curriculum. This is the first multisite, randomized trial assessing satisfaction, knowledge impact, and behavior change in a virtually simulated environment with pediatric trainees.

PEMNetwork: Barriers and Enablers to Collaboration and Multimedia Education in the Digital Age

In January 2005, PEMFellows.com was created to unify fellows in pediatric emergency medicine. Since then, the website has expanded, contracted, and focused to adapt to the interests of the pediatric emergency medicine practitioner during the internet boom. This review details the innovation of the PEMNetwork, from the inception of the initial website and its evolution into a needs-based, user-directed educational hub. Barriers and enablers to success are detailed with unique examples from descriptive analysis and metrics of PEMNetwork web traffic as well as examples from other online medical communities and digital education websites.

Viability of a Web-Based Module for Teaching Electrocardiogram Reading Skills to Psychiatry Residents: Learning Outcomes and Trainee Interest

OBJECTIVE

Web-based instruction in post-graduate psychiatry training has shown comparable effectiveness to in-person instruction, but few topics have been addressed in this format. This study sought to evaluate the viability of a web-based curriculum in teaching electrocardiogram (EKG) reading skills to psychiatry residents. Interest in receiving educational materials in this format was also assessed.

METHODS

A web-based curriculum of 41 slides, including eight pre-test and eight post-test questions with emphasis on cardiac complications of psychotropic medications, was made available to all psychiatry residents via email.

RESULTS

Out of 57 residents, 30 initiated and 22 completed the module. Mean improvement from pre-test to post-test was 25 %, and all 22 completing participants indicated interest in future web-based instruction.

CONCLUSIONS

This pilot study suggests that web-based instruction is feasible and under-utilized as a means of teaching psychiatry residents. Potential uses of web-based instruction, such as tracking learning outcomes or patient care longitudinally, are also discussed.

The feasibility of e-learning as a quality improvement tool

RATIONAL, AIMS AND OBJECTIVES

Many quality problems exist in health care. We aim to investigate the feasibility and acceptability of using e-learning (defined as computer-based learning modules) to address gaps in quality of care.

METHODS

We performed a qualitative evaluation of participants in a pilot e-learning program. Physician members of six medical teaching units (MTUs) at a multi-site tertiary care teaching hospital were asked to complete two e-learning modules addressing hand hygiene practices and management of community-acquired pneumonia (CAP). An e-learning design team created online modules that were made available to members of the six MTUs for 4 weeks using a password secured website. Use of the modules was voluntary. Participants' perceptions of module content, mode of delivery, and suggestions for improvement were determined through focus groups. We then performed content analysis on the transcripts. We used system data to define patterns of module access.

RESULTS

Out of 55 eligible users, 30 (55%) logged onto the system at least once. Residents (14/30, 47%) were less likely to use the system than medical students (9/14, 64%) and attending staff (7/11, 64%). Learners at all levels thought the modules were easy to use. Participants liked the knowledge-based material in the CAP module because it directly applied to their work. There were less favourable opinions of the hand hygiene module

CONCLUSIONS

Generating e-learning modules targeted at gaps in quality of care is feasible and acceptable to learners. Future studies should assess whether these approaches lead to desired changes in behavior.

Pediatric emergency medicine asynchronous e-learning: a multicenter randomized controlled Solomon four-group study

OBJECTIVES

Asynchronous e-learning allows for targeted teaching, particularly advantageous when bedside and didactic education is insufficient. An asynchronous e-learning curriculum has not been studied across multiple centers in the context of a clinical rotation. We hypothesize that an asynchronous e-learning curriculum during the pediatric emergency medicine (EM) rotation improves medical knowledge among residents and students across multiple participating centers.

METHODS

Trainees on pediatric EM rotations at four large pediatric centers from 2012 to 2013 were randomized in a Solomon four-group design. The experimental arms received an asynchronous e-learning curriculum consisting of nine Web-based, interactive, peer-reviewed Flash/HTML5 modules. Postrotation testing and in-training examination (ITE) scores quantified improvements in knowledge. A 2 × 2 analysis of covariance (ANCOVA) tested interaction and main effects, and Pearson's correlation tested associations between module usage, scores, and ITE scores.

RESULTS

A total of 256 of 458 participants completed all study elements; 104 had access to asynchronous e-learning modules, and 152 were controls who used the current education standards. No pretest sensitization was found (p = 0.75). Use of asynchronous e-learning modules was associated with an improvement in posttest scores (p < 0.001), from a mean score of 18.45 (95% confidence interval [CI] = 17.92 to 18.98) to 21.30 (95% CI = 20.69 to 21.91), a large effect (partial η(2) = 0.19). Posttest scores correlated with ITE scores (r(2) = 0.14, p < 0.001) among pediatric residents.

CONCLUSIONS

Asynchronous e-learning is an effective educational tool to improve knowledge in a clinical rotation. Web-based asynchronous e-learning is a promising modality to standardize education among multiple institutions with common curricula, particularly in clinical rotations where scheduling difficulties, seasonality, and variable experiences limit in-hospital learning.

Educational technology improves ECG interpretation of acute myocardial infarction among medical students and emergency medicine residents

INTRODUCTION

Asynchronous online training has become an increasingly popular educational format in the new era of technology-based professional development. We sought to evaluate the impact of an online asynchronous training module on the ability of medical students and emergency medicine (EM) residents to detect electrocardiogram (ECG) abnormalities of an acute myocardial infarction (AMI).

METHODS

We developed an online ECG training and testing module on AMI, with emphasis on recognizing ST elevation myocardial infarction (MI) and early activation of cardiac catheterization resources. Study participants included senior medical students and EM residents at all post-graduate levels rotating in our emergency department (ED). Participants were given a baseline set of ECGs for interpretation. This was followed by a brief interactive online training module on normal ECGs as well as abnormal ECGs representing an acute MI. Participants then underwent a post-test with a set of ECGs in which they had to interpret and decide appropriate intervention including catheterization lab activation.

RESULTS

148 students and 35 EM residents participated in this training in the 2012-2013 academic year. Students and EM residents showed significant improvements in recognizing ECG abnormalities after taking the asynchronous online training module. The mean score on the testing module for students improved from 5.9 (95% CI [5.7-6.1]) to 7.3 (95% CI [7.1-7.5]), with a mean difference of 1.4 (95% CI [1.12-1.68]) (p<0.0001). The mean score for residents improved significantly from 6.5 (95% CI [6.2-6.9]) to 7.8 (95% CI [7.4-8.2]) (p<0.0001).

CONCLUSION

An online interactive module of training improved the ability of medical students and EM residents to correctly recognize the ECG evidence of an acute MI.

Is there a place for e-learning in infection prevention?

BACKGROUND

In the last few decades, e-learning, a method which integrates information technology and the learning process by using materials delivered through the internet, has become widely used in educational initiatives for healthcare professionals.

PURPOSE

To evaluate whether there is a place for e-learning in the field of infection prevention.

METHODS

Non-comprehensive review of the literature.

FINDINGS

E-learning courses in the field of infection prevention and control are still scarce, often restricted to local initiatives and not specifically directed toward critical care providers. Although methodological flaws and potential biases hamper the generalizability of results from some currently available studies, findings related to both learners' satisfaction and effectiveness suggest that e-learning might prove an effective educational tool for the (continuing) education of healthcare providers. Further investigations, including research pertaining to the cost-effectiveness of e-learning, are required to provide a better insight in these issues.

CONCLUSION

Further research is required to determine the (cost)effectiveness of e-learning in general, and in the field of infection prevention and control in particular. Current insights suggest that e-learning should be based Web 2.0 technologies to address a wide range of learning styles and to optimize interactivity. As a gap in the literature was detected with respect to e-learning modules on infection prevention and control which are specifically oriented toward critical care providers, it can be recommended to promote the development and subsequent assessment of such tools that meet high-quality standards.