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

The effect of case-based mobile virtual patient application on students' academic achievement in clinical reasoning skills

This mixed-method study aims to determine the effect of the use of mobile virtual patient application with narrated case-based virtual patients as an assistive technology on students' clinical reasoning skills. It makes a notable contribution by exploring the impact of mobile virtual patient applications on healthcare students' clinical skills and their preparation for real-world patient care. In addition, the accuracy of the analysis results regarding the effect on student achievement was analyzed with a second dataset tool, and thus, aiming to increase reliability by verifying the same research question with a different quantitative analysis technique. In the qualitative part of the study, students' views on the implementation were collected through an open-ended questionnaire and the data were subjected to content analysis. An achievement test was also developed to determine the development of students' clinical reasoning skills, which revealed that each of the learning environments had different outcomes regarding students' achievement and that supporting the traditional environment with the mobile virtual patient application yielded better results for increasing students' achievement. Students' opinions about the mobile virtual patient application and the process also support the increase in academic achievement aimed at measuring clinical reasoning skills. The content analysis showed that the students, who generally reported multiple positive factors related to the application, thought that the stories and cases presented created a perception of reality, and they especially highlighted the contribution of the application to learning the story organization. Based on all these results, it can be said that the application supports clinical reasoning, provides practical experience, improves academic achievement, and contributes positively to motivation.

Resilience in Oral Health Professional Education: A Scoping Review

INTRODUCTION

Resilience is defined as an individual's capacity to effectively adapt in the face of challenges without detrimental effects on their health and well-being. This scoping review identifies and rationalises the published concepts that underpin resilience in oral health professional (OHP) education. It provides recommendations for the development of evidence-based strategies for promoting resilience in OHP education.

METHODS

The PRISMA and Arksey and O'Malley methodological frameworks for scoping reviews were used to determine the methodology and answer the question 'What concepts contribute to resilience in OHP Education?'. The search strategy included published literature searches and internet searches.

RESULTS

In total, 744 articles on resilience and coping were identified, and 59 were included after excluding irrelevant records. Most studies used surveys as their study design and focused on undergraduate dental students in North America and Asia. Three main themes were identified: factors that contribute to resilience, measurement tools and scales and enhancing resilience. This review highlights a positive correlation between increased resilience and improved outcomes for dental students.

CONCLUSION

Resilience and its related factors are not well understood. There is insufficient evidence to support interventions for building resilience due to inconsistent measuring methods and limited research validating resilience scales in OHP education. Investigators should accurately understand the terminology for clarity and consistency. Validated outcome measures and student feedback should be used to determine the effectiveness of interventions. It is important to teach students coping strategies to manage stressors, and digital applications for building resilience should be developed and tested in OHP student populations.

LapBot-Safe Chole: validation of an artificial intelligence-powered mobile game app to teach safe cholecystectomy

BACKGROUND

Gaming can serve as an educational tool to allow trainees to practice surgical decision-making in a low-stakes environment. LapBot is a novel free interactive mobile game application that uses artificial intelligence (AI) to provide players with feedback on safe dissection during laparoscopic cholecystectomy (LC). This study aims to provide validity evidence for this mobile game.

METHODS

Trainees and surgeons participated by downloading and playing LapBot on their smartphone. Players were presented with intraoperative LC scenes and required to locate their preferred location of dissection of the hepatocystic triangle. They received immediate accuracy scores and personalized feedback using an AI algorithm ("GoNoGoNet") that identifies safe/dangerous zones of dissection. Player scores were assessed globally and across training experience using non-parametric ANOVA. Three-month questionnaires were administered to assess the educational value of LapBot.

RESULTS

A total of 903 participants from 64 countries played LapBot. As game difficulty increased, average scores (p < 0.0001) and confidence levels (p < 0.0001) decreased significantly. Scores were significantly positively correlated with players' case volume (p = 0.0002) and training level (p = 0.0003). Most agreed that LapBot should be incorporated as an adjunct into training programs (64.1%), as it improved their ability to reflect critically on feedback they receive during LC (47.5%) or while watching others perform LC (57.5%).

CONCLUSIONS

Serious games, such as LapBot, can be effective educational tools for deliberate practice and surgical coaching by promoting learner engagement and experiential learning. Our study demonstrates that players' scores were correlated to their level of expertise, and that after playing the game, most players perceived a significant educational value.

Hotspots and Global Trends of Nursing Research on Mobile Applications in Nursing From 2012 to 2023: A Bibliometric Analysis

The rapid integration of mobile applications in healthcare has prompted an evolutionary change in nursing domain. This study aimed to systematically analyze the basic publication characteristics, research priorities, emerging trends, and thematic evolutions concerning mobile applications in nursing, providing an overview of the field's developmental trajectory and future directions. This was a descriptive bibliometric study. Data were collected on July 5, 2023, from the Web of Science database and analyzed by using the Bibliometrix package in R software. The search strategy yielded 417 documents authored by 1969 researchers, cited 12 595 references, and featured 1213 author keywords, spanning from 2012 to 2023. Research on mobile applications in nursing exhibited several key trends: (1) substantial collaboration among authors; (2) significant growth in the number of publications; (3) self-management was the most prominent hot topic; and (4) an evolution of research themes from general topics to a more specific focus on people-centered and problem-centered research. The corpus of literature pertaining to research on mobile applications within the nursing domain is anticipated to expand continually. Future research and practice in the nursing field are expected to benefit significantly from multidisciplinary collaboration and advancements in emerging technologies, including artificial intelligence.

Mobile Applications for Learning Hand Hygiene: A Comparative Analysis

Infection control is crucial for high-quality patient care. One of the most effective and commonly used infection control procedures is hand hygiene which, it is known, requires repeated refresher training. There are many ways to educate healthcare professionals about hand hygiene, including the use of mobile applications (apps). Our aim is to review such hand hygiene apps, and to identify which have been available since 2021 and to assess their quality. We conducted a review using the PRISMA diagram to document our app selection process in the Google Play Store and Apple store in March 2024. For the evaluation of apps, we used the user version of the Mobile Application Rating Scale questionnaire (uMARS). Of 16 apps only five adhere to WHO hand hygiene guidelines. Timers were included in 12 of the 16 apps and reminders were included in 10 of 16 apps. The highest overall uMARS scoring app was Give Me 5-Hand Hygiene (4.31 ± 0.28), while Wash your hands! (1.17 ± 0.14) had the lowest score. We found that more than half of the apps were unavailable from the 2021 review. We believe that app-based education could effectively sustain hand hygiene knowledge in healthcare settings.

Evaluation of Mobile Apps Used among Medical Students for Learning and Education: A Mixed-Method Concurrent Triangulation Approach

BACKGROUND

 The use of medical mobile applications (apps) to enhance learning is widespread in medical education. Despite the large number of medical apps used among medical students for learning, many apps have not been evaluated using validated instruments. Finding relevant and valuable apps for student learning might be difficult.

OBJECTIVE

 The objective is to evaluate four medical apps (AMBOSS, ISABEL, Medscape, and OSMOSIS) in improving just-in-time learning among medical students using the Mobile App Rubric for Learning (MARuL).

METHODS

 We employed a mixed-method concurrent triangulation approach. The study included the entire population of third-year medical students at King Saud University. These students were selected due to their use of medical apps for learning for at least 1 year. The MARuL, which consists of four measures: Teaching and Learning, User-centered, Professional, and Usability, was electronically distributed to medical students for assessment. Descriptive statistics were calculated for all measures, and thematic content analysis was applied to analyze responses to open-ended questions.

RESULTS

 The MARuL evaluation revealed that the OSMOSIS app received the highest Usefulness for Learning Score, with Usability Measures being the most positively evaluated measure. Following was the AMBOSS app, which scored highest in the Professional Measures, along with the Medscape and the ISABEL apps. We identified several key features and challenges from analyzing students' responses to open-ended questions regarding the use of the four medical apps. These included six themes: (1) study support and learning tools, (2) comprehensive information, (3) interface experience, (4) cost and accessibility issues, (5) learning methods and content limitations, and (6) user experience and technical issues.

CONCLUSION

 Equipping medical students with the ability to evaluate and choose medical apps that facilitate just-in-time learning is a crucial element that should be integrated into the medical curriculum.

Simulation-Based Training Program for Peripherally Inserted Central Catheter Placement: Randomized Comparative Study of in-Person Training With Synchronous Feedback Versus Distance Training With Asynchronous Feedback

INTRODUCTION

Simulation training that includes deliberate practice is effective for procedural skill training. Delivering feedback remotely and asynchronously has been examined for more cost-efficient training. This prospective randomized study aimed to compare 2 feedback techniques for simulation training: synchronous direct feedback versus asynchronous distance feedback (ASYNC).

METHODS

Forty anesthesia and internal medicine residents were recruited after study approval by the institutional ethics committee. Residents reviewed instructional material on an online platform and performed a pretraining assessment (PRE) for peripherally inserted central catheter (PICC) placement. Each resident was then randomly assigned to 1 of 2 training types, practice with synchronous direct feedback (SYNC) or practice with ASYNC. Training consisted of four, 1-hour practice sessions; each was conducted once per week. Both groups underwent posttraining evaluation (POST). The PRE and POST assessments were videotaped and evaluated by 2 independent, blinded reviewers using a global rating scale.

RESULTS

Thirty-five residents completed the training program and both evaluations. Both groups had significantly improved global rating scale scores after 4 sessions. The SYNC group improved from 28 to 45 points (P < 0.01); the ASYNC group improved from 26.5 to 46 points (P < 0.01). We found no significant between-group differences for the PRE (P = 0.42) or POST assessments (P = 0.13).

CONCLUSION

This simulation-based training program significantly improved residents' peripherally inserted central venous catheter placement skills using either modality. With these results, we are unable to demonstrate the superiority of synchronous feedback over ASYNC. Asynchronous feedback training modality represents a new, innovative approach for health care procedural skills training.

Is the European Crohn's and Colitis organisation (ECCO) e-guide an acceptable and feasible tool for increasing gastroenterologists' guideline adherence? A mixed methods evaluation

BACKGROUND AND AIMS

Management of inflammatory bowel disease is constantly evolving, increasing the importance for gastroenterologists to keep up to date with guidelines. Traditional implementation strategies have had only small positive impacts on clinical practice. eHealth strategies such as the European Crohn's and Colitis Organisation e-guide may be beneficial for clinician decision making in keeping with guidelines. The aim of this study was to evaluate the feasibility and acceptability of the e-guide.

METHODS

A mixed methods approach was used to evaluate feasibility and acceptability. Cognitive (think-aloud) interviews were conducted with Australian gastroenterologists while using the e-guide. Two clinical scenarios were developed to allow evaluation of various aspects of the e-guide. Content analysis was applied to the qualitative interview data and descriptive analysis to the quantitative and observational data.

RESULTS

Seventeen participants completed the study. Data saturation were reached. The ECCO e-guide was largely feasible and acceptable, as demonstrated by most clinical questions answered correctly, 87% reaching the answer within 3 min, and most feeling it was useful, would be beneficial to their practice and would use it again. Issues raised included difficulties with website navigation, layout of the e-guide and difficulties with access (network firewalls, paid subscription required).

CONCLUSIONS

The ECCO e-guide is largely acceptable and feasible for gastroenterologists to use. Aspects of the e-guide could be modified to improve user experience. This study highlights the importance of engaging end-users in the development and evaluation of clinician educational tools.

Usage and attitude of medical students towards mobile medical applications during and after COVID-19 lockdown: repeated cross-sectional study

BACKGROUND

COVID-19 pandemic has accelerated the shift toward e-learning, particularly in medical education. Mobile medical applications (apps) have become integral tools for e-learning due to the prevalence of smartphones among medical students. Therefore, we aim to assess the usage and attitude of undergraduate Egyptian medical students towards mobile medical apps during and after the COVID-19 lockdown.

METHODS

This is a two-phase repeated cross-sectional study using an online, pilot-tested, and self-administered survey conducted at the Faculty of Medicine, Menoufia University, Egypt. Phase 1 was during the academic year 2019-2020 (during lockdown), and phase 2 was during the academic year 2021-2022 (after lockdown). Out of the 4800-target population for each phase, a sample size of 140 medical students was randomly selected from each study year, resulting in a total sample size of 840 students for all six academic and clinical years for each phase.

RESULTS

A total of 566 students in phase 1 and 616 students in phase 2 responded to the survey, with response rates of 67.62% and 73.33%, respectively. In phase 1, 55.7% of students reported using medical apps, with no significant difference between males and females (60.1% vs. 53.8%; p = 0.17) or between academic and clinical years (56.3% vs. 54.7%; p = 0.7). In phase 2, the percentage increased to 70.9%, with a significant difference between males and females (80% vs. 62.9%; p < 0.001) and between academic and clinical years (79.8% vs. 63%; p < 0.001). Medical dictionaries were the most commonly used apps, whereas medical calculators were the least common in both phases. Regarding their attitude, most students (65.1% and 73.9% in phases 1 and 2, respectively) expressed confidence in using medical apps, while 81.3% in phase 1 and 88.1% in phase 2 agreed that using medical apps is a flexible method of learning. Lack of knowledge regarding which app to download was the most reported cause of limitation in medical app usage by 37.8% of the students in phase 1 and 40% in phase 2.

CONCLUSION

Our study revealed that the COVID-19 lockdown led to a significant increase in the use of mobile medical apps among Egyptian medical students. Despite the positive attitude of students towards these apps, multiple challenges still need to be addressed to ensure their optimal utilization in medical education.

One decade of "English as a medium of instruction" (EMI) in healthcare education

Introduction

This paper analyzes published healthcare studies about "English as a medium of instruction" (EMI), indexed in the Scopus database from 2013 to 2022.

Methods

The author used published criteria of systematic reviews and limited the findings to healthcare education using several key terms; this returned 137 articles. The author then downloaded and carefully read the articles. The majority of articles (102) were deleted because they did not meet the selection criteria discussed in the methods section, thus the final list comprised 35 research studies. Next, the author analyzed the articles' bibliometric indexes, such as author, funding information, context, research instruments, years of publication, place of publication, and citations. In addition, the key findings and recommendations of these studies were presented.

Results and discussion

Most of the studies assessed were conducted in the last five years in Arabic speaking countries by non-language specialists, and the language of instruction was not the main focus of the studies. The studies were most often about attitudes of students, and used quantitative methods such as questionnaires. The results show diverse and conflicted results such as positive impacts and positive attitudes in some cases, negative impacts and attitudes in others, and preferences for either monolingual or bilingual approaches. The findings demonstrate the need for experimental and rigorous mixed methods studies that involve different stakeholders and are conducted by both applied linguists and healthcare education specialists. Future research should move beyond student attitudes and utilize rigorous mixed methods involving researchers from both linguistics and healthcare education to deepen our understanding of EMI's complex impact in diverse contexts.

Mobile Application Increased Nutrition Knowledge Among Brazilian Physicians

OBJECTIVE

To assess whether using a Dietary Approaches to Stop Hypertension (DASH) diet recommendation application increases primary care physicians' knowledge and dietary counseling skills.

DESIGN

A randomized controlled trial.

SETTING

Brazilian public primary care service.

PARTICIPANTS

Two hundred and twenty-two physicians (intervention group: n = 111; control group: n = 111).

INTERVENTION

Thirty days of using the Dieta Dash application. The application provides information about nutritional recommendations for hypertension management.

MAIN OUTCOME MEASURES

Nutrition knowledge score.

SECONDARY OUTCOMES

self-assessment of knowledge, self-confidence, assessment of eating habits, and barriers to dietary counseling.

ANALYSIS

Linear mixed-effects models for repeated measures and generalized estimating equations for comparing changes between groups.

RESULTS

A total of 66.2% of participants completed the follow-up. There was no significant difference between the groups regarding the mean knowledge score (P = 0.15). The prevalence of high knowledge increased by 12% (prevalence ratio [PR] = 1.12; 95% confidence interval [CI], 1.00-1.25) in the intervention group and showed an improvement in the self-confidence assessment (PR = 1.21; 95% CI, 1.02-1.44), and increased assessment of eating habits (PR = 1.26; 95% CI, 1.10-1.55).

CONCLUSIONS AND IMPLICATIONS

The Dieta Dash application helped address dietary counseling, improving knowledge and self-confidence. However, innovative strategies are needed to minimize the primary care barriers.

Development and usability testing of a patient digital twin for critical care education: a mixed methods study

Background

Digital twins are computerized patient replicas that allow clinical interventions testing in silico to minimize preventable patient harm. Our group has developed a novel application software utilizing a digital twin patient model based on electronic health record (EHR) variables to simulate clinical trajectories during the initial 6 h of critical illness. This study aimed to assess the usability, workload, and acceptance of the digital twin application as an educational tool in critical care.

Methods

A mixed methods study was conducted during seven user testing sessions of the digital twin application with thirty-five first-year internal medicine residents. Qualitative data were collected using a think-aloud and semi-structured interview format, while quantitative measurements included the System Usability Scale (SUS), NASA Task Load Index (NASA-TLX), and a short survey.

Results

Median SUS scores and NASA-TLX were 70 (IQR 62.5-82.5) and 29.2 (IQR 22.5-34.2), consistent with good software usability and low to moderate workload, respectively. Residents expressed interest in using the digital twin application for ICU rotations and identified five themes for software improvement: clinical fidelity, interface organization, learning experience, serious gaming, and implementation strategies.

Conclusion

A digital twin application based on EHR clinical variables showed good usability and high acceptance for critical care education.

Novel interactive text-messaging curriculum for endocrinology board review

Background

The ABIM certification exam is one of the measures to ensure that physicians have the clinical skills for good care delivery. The 5-year average pass rate for ABIM Endocrinology exam is 82%. The pass rate significantly decreased to a nadir of 74% in 2021 and 2022, lowest of all medicine subspecialties.

Objectives

To assess the feasibility of text messaging curriculum for fellows and its utility in improving their test performance.

Methods

In 2021, endocrinology fellows from 51 programs across the country were invited to participate in our curriculum. They completed a pre-test, joined a texting group via Remind application and received 1 multiple choice question daily (total n = 78). After 15 weeks, they completed a post-test and survey. Paired results from pre- and post-test were compared.

Results

A total of 89 fellows from 27 programs responded. Of these, 82 fellows, predominantly females (n = 60; 73 %), filled out the pre-test. On an average, 42 fellows (SD = 12) responded to the questions daily and 57 % of them answered the questions within 24 h. Thirty fellows completed the post-test. The median number of correct responses on the pre-test was 5 (IQR 3-6), compared to 8 (IQR 6-9) in the post-test. There was a significant improvement (p-value < 0.0001) in fellows' performance in the post-test when compared with the pre-test following our intervention.

Conclusions

Text-messaging based curriculum for exam preparation is feasible and can improve test performance. Fellows find receiving a daily high yield multiple choice question via text-message as a useful tool for exam preparation.

Mobile applications in radiology: own study based on polish data

As the number of smartphones increases, so does the number of medical apps. Medical mobile applications are widely used in many medical fields by both patients and doctors. However, there are still few approved mobile applications that can be used in the diagnostic-therapeutic process and radiological apps are affected as well. We conducted our research by classifying radiological applications from the Google Play® store into appropriate categories, according to our own qualification system developed by researchers for the purposes of this study. In addition, we also evaluated apps from the App Store®. The radiology application rating system we created has not been previously used in other articles. Out of 228 applications from the Google Play store, only 6 of them were classified as "A" category with the highest standard. Apps from the App Store (157) were not categorized due to the lack of download counts, which was necessary in our app-rating system. The vast majority of applications are for educational purposes and are not used in clinical practice. This is due to the need of obtaining special permits and certificates from relevant institutions in order to use them in medical practice. We recommend applications from the Google Play store that have been classified in the "A" category, evaluating them as the most valuable. App Store apps data is described and presented in the form of diagrams and tables.

Survey on Blockchain-Based Data Storage Security for Android Mobile Applications

This research paper investigates the integration of blockchain technology to enhance the security of Android mobile app data storage. Blockchain holds the potential to significantly improve data security and reliability, yet faces notable challenges such as scalability, performance, cost, and complexity. In this study, we begin by providing a thorough review of prior research and identifying critical research gaps in the field. Android's dominant position in the mobile market justifies our focus on this platform. Additionally, we delve into the historical evolution of blockchain and its relevance to modern mobile app security in a dedicated section. Our examination of encryption techniques and the effectiveness of blockchain in securing mobile app data storage yields important insights. We discuss the advantages of blockchain over traditional encryption methods and their practical implications. The central contribution of this paper is the Blockchain-based Secure Android Data Storage (BSADS) framework, now consisting of six comprehensive layers. We address challenges related to data storage costs, scalability, performance, and mobile-specific constraints, proposing technical optimization strategies to overcome these obstacles effectively. To maintain transparency and provide a holistic perspective, we acknowledge the limitations of our study. Furthermore, we outline future directions, stressing the importance of leveraging lightweight nodes, tackling scalability issues, integrating emerging technologies, and enhancing user experiences while adhering to regulatory requirements.

Application of machine learning and its effects on the development of a nursing guidance mobile app for sarcopenia

BACKGROUND

Aging leads to changes in the body system, such as sarcopenia. This can result in several health issues, particularly physical and mobility dysfunction. Asian people typically have little awareness of sarcopenia. Thus, this study incorporated nursing instruction into the mobile application design to allow users to easily learn about sarcopenia.

OBJECTIVE

This study evaluated a model for predicting high-risk populations for sarcopenia in home settings. We further developed a sarcopenia nursing guidance mobile application and assessed the effectiveness of this application in influencing sarcopenia-related knowledge and self-care awareness among participants.

METHODS

Using a one-group pretest-posttest design, data were collected from 120 participants at a teaching hospital in northern Taiwan. This study used an artificial intelligence algorithm to evaluate a model for predicting high-risk populations for sarcopenia. We developed and assessed the sarcopenia nursing guidance mobile application using a questionnaire based on the Mobile Application Rating Scale.

RESULTS

The application developed in this study enhanced participants' sarcopenia-related knowledge and awareness regarding self-care. After the three-month intervention, the knowledge and awareness was effectively increase, total score was from 4.15 ± 2.35 to 6.65 ± 0.85 and were significant for all questionnaire items (p values < 0.05). On average, 96.1% of the participants were satisfied with the mobile app. The artificial intelligence algorithm positively evaluated the home-use model for predicting high-risk sarcopenia groups.

CONCLUSIONS

The mobile application of the sarcopenia nursing guidance for public use in home settings may help alleviate sarcopenia symptoms and reduce complications by enhancing individuals' self-care awareness and ability.

TRIAL REGISTRATION

NCT05363033, registered on 02/05/2022.

The Use of mHealth Apps for the Assessment and Management of Diabetes-Related Foot Health Outcomes: Systematic Review

BACKGROUND

Globally, diabetes affects approximately 500 million people and is predicted to affect up to 700 million people by 2045. In Australia, the ongoing impact of colonization produces inequity in health care delivery and inequality in health care outcomes for First Nations Peoples, with diabetes rates 4 times those of non-Indigenous Australians. Evidence-based clinical practice has been shown to reduce complications of diabetes-related foot disease, including ulceration and amputation, by 50%. However, factors such as a lack of access to culturally safe care, geographical remoteness, and high costs associated with in-person care are key barriers for First Nations Peoples in accessing evidence-based care, leading to the development of innovative mobile health (mHealth) apps as a way to increase access to health services and improve knowledge and self-care management for people with diabetes.

OBJECTIVE

This study aims to evaluate studies investigating the use of mHealth apps for the assessment and management of diabetes-related foot health in First Nations Peoples in Australia and non-Indigenous populations globally.

METHODS

PubMed, Informit's Indigenous Collection database, Ovid MEDLINE, Embase, CINAHL Complete, and Scopus were searched from inception to September 8, 2022. Hand searches of gray literature and reference lists of included studies were conducted. Studies describing mHealth apps developed for the assessment and management of diabetes-related foot health were eligible. Studies must include an evaluation (qualitative or quantitative) of the mHealth app. No language, publication date, or publication status restrictions were used. Quality appraisal was performed using the revised Cochrane risk-of-bias tool for randomized trials and the Health Evidence Bulletins Wales checklists for observational, cohort, and qualitative studies.

RESULTS

No studies specifically including First Nations Peoples in Australia were identified. Six studies in non-Indigenous populations with 361 participants were included. Foot care education was the main component of all mHealth apps. Of the 6 mHealth apps, 2 (33%) provided functionality for participants to enter health-related data; 1 (17%) included a messaging interface. The length of follow-up ranged from 1-6 months. Of the 6 studies, 1 (17%) reported high levels of acceptability of the mHealth app content for self-care by people with diabetes and diabetes specialists; the remaining 5 (83%) reported that participants had improved diabetes-related knowledge and self-management skills after using their mHealth app.

CONCLUSIONS

The findings from this systematic review provide an overview of the features deployed in mHealth apps and indicate that this type of intervention can improve knowledge and self-care management skills in non-Indigenous people with diabetes. Future research needs to focus on mHealth apps for populations where there is inadequate or ineffective service delivery, including for First Nations Peoples and those living in geographically remote areas, as well as evaluate direct effects on diabetes-related foot disease outcomes.

TRIAL REGISTRATION

PROSPERO CRD42022349087; https://tinyurl.com/35u6mmzd.

Why the role of mHealth in allergy diagnosis and treatment adherence cannot be overlooked

BACKGROUND

Allergic diseases-rhinitis and asthma-are the most common chronic conditions affecting adults. Traditional approaches to allergy diagnosis and treatment do not meet the health needs of all patients. Treatment adherence remains a challenge for physicians. The ubiquity of Internet access paired with limited in-person contact with medical personnel in the course of the COVID-19 pandemic demonstrated the potential of mHealth in communicating health information. BODY: The abundance of new applications dedicated to various medical specialties encourages reflection on the informed use of such tools. The paper takes a closer look at the potential of mHealth and presents conclusions of selected studies focusing on the use of good apps. The strength weakness opportunities threats analysis was used to illustrate the strengths of the mHealth strategy, as well as its advantages, limitations and areas in need of further development.

CONCLUSION

The strength of mHealth depends on the quality and quantity of the collected patient data, its reliable processing, as well as publication of outcomes and conclusions from analyses. Therefore, it is necessary to promote the use of validated applications among patients, physicians and medical staff.

Perceived Usefulness of Smartphone Medical Apps As Theoretical and Clinical Learning Aids Among Medical Students in Pakistan: A Cross-Sectional Study

Background Smartphone applications have become popular tools in clinical educational environments, particularly because they enhance learning in any setting through their accessibility. Despite students utilizing these apps in their daily learning, Pakistan's medical education system has yet to strongly endorse them. Given the rising usage of medical applications among clinical year medical students and the wide range of apps accessible on contemporary devices aimed specifically at the student population, there is a lack of literature addressing the use of these apps on clinical learning in low- and middle-income countries (LMIC) such as Pakistan. Objectives Our study aims to (1) assess the level of awareness among clinical-year medical students in Pakistan, of smartphone applications for academic purposes, (2) determine the usefulness of medical apps as educational tools for clinical-year medical students, in terms of enhancing overall patient-care skills and (3) identify barriers to the usage of apps among students who do not have them installed. Methods This online questionnaire-based study includes clinical year medical students across four medical colleges (two private and two public sectors) in Pakistan. Participant identity was kept anonymous and informed consent was required to participate. A sample size of 360 was used based on previous studies in the UK and student estimates from chosen medical colleges. The questionnaire tool used consists of three sections; demographics and medical school information, perceived usefulness of medical smartphone apps on a Likert Scale and barriers to usage among students who do not have them installed. Results 97.9% of the total study population chose to participate in the study. There was roughly an equal percentage of responses from each clinical year and 72% of students reported active use of medical apps of which the vast majority (48%) have one to two apps on their phones. Only 39% of students felt that their medical colleges encourage the use of smartphone apps for academic purposes. 54% of students use apps to look up medical criteria for disease processes and almost 42% use them to search medications. On a Likert scale of 1-5, improvement of clinical performance received highest average score among users (3.92, SD 1.1), followed by quick access to medical guidelines (3.83, SD 1.0). The most common reasons for nonuse of medical apps were medical colleges not offering subscriptions and not knowing how to utilize apps. Conclusion Smartphone apps are widely used by clinical year medical students for academic purposes in our study. Despite lack of endorsement from their respective medical colleges, these apps are still popularly utilized for revision and research on disease criteria during clinics and rounds. Encouragement from the university has been identified as a significant barrier, however. Students who use smartphone apps reported an improvement in clinical performance overall; they were able to retrieve information quicker during rounds and noticed enhancements in formulating diagnoses and reading radiological images. In contrast, those not using these apps faced challenges with interpreting imaging results, recalling pharmacological properties of medications and developing differential diagnoses. Through these findings, we highlight the benefits of incorporating technological media into the undergraduate curriculum and hope medical universities from Pakistan can take inspiration.

Evaluation and Comparison of Two Media-Rich Radiology Apps Regarding Pathology of the Lumbar Spine: Lessons for Medical Education App Developers and Content Creators

BACKGROUND

Mobile applications have become an increasingly popular component of medical education over the past 2 decades. Visual layout and aesthetics are important considerations in app design given Generation Z's strong preference for visually appealing digital content. In this study, we evaluate students' perceptions of an educational app related to pathology of the lumbar spine before and after a redesign of its workflow and illustrations.

OBJECTIVE, MATERIAL AND METHODS

A professional user experience and interface designer was recruited for the revision of an iOS app focused on anatomy and pathology of the lumbar spine on abdominal computed tomography (CT). Revisions focused on developing the app to make it more visually appealing, increasing ease of use, and fixing bugs. An IRB-approved study was conducted in which participants were asked to interact with the original and revised versions of the app prior to completing a survey regarding their perception of the graphics, animation style, overall app design, and content.

RESULTS

Overall impressions of the revised app were more positive than the original app, with 89% of respondents finding the revised app's graphics to be visually appealing compared to 39% regarding the original app. Further, 95% of respondents indicated that the revised app's layout was organized and user-friendly compared to 73% regarding the original. Both apps received similarly positive ratings for participants' understanding of the presented materials.

CONCLUSION

User feedback is key when designing mobile health and educational applications. Feedback may be sought via formal usability testing or app-specific surveys. The aesthetics, layout, and ease of use of mobile apps are important considerations and, in the absence of content alteration, may influence user engagement. Knowledge regarding these factors may guide content creators when developing and deploying mobile health applications.

Understanding the inclination of South Indian nursing graduates in using mobile learning applications

BACKGROUND

Clinical-based mobile learning courses have great demand among the nursing graduates as learners look for possibilities to update skills. The present study explores the feasibility, familiarity, utility, and attitude of nursing graduates of South India toward mobile learning applications (m-apps).

MATERIAL AND METHODS

An online-based cross-sectional descriptive survey was conducted in May 2021 among the South Indian nursing graduates of Tamil Nadu and Kerala, using a questionnaire consisting 49 items categorized under six sections with items related to socio-demographic information; m-app usage; online learning experience; preference in using m-apps for learning purposes before COVID-19 and during COVID-19; students' engagement through e-learning; and anxiety related to online assessment. Descriptive and inferential (ANOVA, Chi-square, and t test) statistical data analysis were done using SPSS version 23.

RESULTS

A total of 447 student nurses responded. The result shows that most of them, 96% (432) used android phones and 94% (422) owned a mobile. Age was highly influencing mobile learning application (m-learning apps) usage; students of less than 20 years of age used applications more frequently and possessed more educational applications. Majority of them, 84% (377) of them had started using m-learning apps only after COVID. 57.7% (249) commonly used m-learning apps for acquiring nursing knowledge resources, nursing exam preparatory, and drug resources. Students rated high for the interactive nature of these m-learning apps, while abundant learning materials and usage with ease were rated as other attractive features. Sixty-six percent (305) had mostly downloaded these apps from Google Play Store.

CONCLUSION

The findings would help the m-learning application developers to offer customize solutions to address learning gaps that prevail among the South Indian nursing graduates and help with sustainable growth.

The Use of Telegram in Surgical Education: Exploratory Study

BACKGROUND

The COVID-19 pandemic has disrupted medical education, shifting learning online. Social media platforms, including messaging apps, are well integrated into medical education. However, Telegram's role in medical education remains relatively unexplored.

OBJECTIVE

This study aims to explore the perceptions of medical students regarding the role of messaging apps in medical education and their experience of using Telegram for surgical education.

METHODS

A Telegram channel "Telegram Education for Surgery Learning and Application (TESLA)" was created to supplement medical students' learning. We invited 13 medical students who joined the TESLA channel for at least a month to participate in individual semistructured interviews. Interviews were conducted via videoconferencing using an interview guide and were then transcribed and analyzed by 2 researchers using inductive thematic content analysis.

RESULTS

Two themes were identified: (1) learning as a medical student and (2) the role of mobile learning (mLearning) in medical education. Students shared that pandemic-related safety measures, such as reduced clinic allocations and the inability to cross between wards, led to a decrease in clinical exposure. Mobile apps, which included proprietary study apps and messaging apps, were increasingly used by students to aid their learning. Students favored Telegram over other messaging apps and reported the development of TESLA as beneficial, particularly for revision and increasing knowledge.

CONCLUSIONS

The use of apps for medical education increased during the COVID-19 pandemic. Medical students commonly used apps to consolidate their learning and revise examination topics. They found TESLA useful, relevant, and trustworthy.

Usefulness of a Mobile Application (Mentali) for Anxiety and Depression Screening in Medical Students and Description of the Associated Triggering Factors

The impact of the COVID-19 health crisis on the mental health of the population requires the implementation of new primary screening strategies of mental health disorders to intervene in a timelier manner, and technology may provide solutions. We aimed to evaluate the usefulness of the mobile app Mentali (version 1.1.2; creators: Jorge Alfonso Solís Galván Sodel Vázquez Reyes, Margarita de la Luz Martínez Fierro, Perla Velasco Elizondo, Idalia Garza Veloz, Alejandro Mauricio González and Claudia Caldera Villalobos, Zacatecas, México) as a primary screening tool for anxiety and depression disorders in medical students and to assess the triggering risk factors. This was a descriptive and longitudinal study and included 155 Mexican medical students. Participants interacted with Mentali for 6 months. The mobile app integrated the Beck anxiety and depression inventories together with a mood module. At the end of the interaction, the students received psychological and psychiatric interventions to confirm their primary diagnoses. Symptoms of moderate/severe anxiety and depression were present in 62.6% and 54.6% of the studied population. When corroborating the diagnoses, Mentali obtained a sensitivity of 100%, 95%, and 43% to classify a mental health disorder, anxiety, and depression, respectively. The most important triggers found were as follows: belonging to a dysfunctional family, being introverted, and having suffered from bullying. The proportion of users with excellent/good mood decreased from 78.7% to 34.4% at the end of the semester, and the proportion of users who claimed to have bad/very bad mood increased from 7.4% to 34.4% at the end of the semester (p < 0.05). Mentali was useful for identifying users with anxiety and/or depression, and as an auxiliary tool to coordinate the provision of specialized interventions, allowing us to increase the proportion of patients who needed psychological care and received it by 30%. The efficacy of Mentali in identifying activities through time with an impact on the mood and mental health of the users was confirmed. Our results support the use of Mentali for the primary screening of mental health disorders in young adults, including medical students.

Mobile health applications: awareness, attitudes, and practices among medical students in Malaysia

BACKGROUND

The popularity of mobile health (mHealth) applications (or apps) in the field of health and medical education is rapidly increasing, especially since the COVID-19 pandemic. We aimed to assess awareness, attitudes, practices, and factors associated with the mHealth app usage among medical students.

METHODS

We conducted a cross-sectional study involving medical students at a government university in Sarawak, Malaysia, from February to April 2021. Validated questionnaires were administered to all consenting students. These questionnaires included questions on basic demographic information as well as awareness, attitude toward, and practices with mHealth apps concerned with medical education, health and fitness, and COVID-19 management.

RESULTS

Respondents had favorable attitudes toward mHealth apps (medical education [61.8%], health and fitness [76.3%], and COVID-19 management [82.7%]). Respondents' mean attitude scores were four out of five for all three app categories. However, respondents used COVID-19 management apps more frequently (73.5%) than those for medical education (35.7%) and fitness (39.0%). Usage of all three app categories was significantly associated with the respondent's awareness and attitude. Respondents in the top 20% in term of household income and study duration were more likely to use medical education apps. The number of respondents who used COVID-19 apps was higher in the top 20% household income group than in the other income groups. The most common barrier to the use of apps was uncertainty regarding the most suitable apps to choose.

CONCLUSION

Our study highlighted a discrepancy between awareness of mHealth apps and positive attitudes toward them and their use. Recognition of barriers to using mHealth apps by relevant authorities may be necessary to increase the usage of these apps.