The Present and Future Applications of Technology in Adapting Medical Education Amidst the COVID-19 Pandemic

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.

Assessment of a virtual prosthetic case planning environment for dental education - A multicentric analysis

OBJECTIVES

The aim of the present study was the multicentric assessment of the virtual prosthetic case planning environment (VCPE), which relocates patient planning into the virtual space in dental education.

MATERIALS AND METHODS

The VCPE is separated into two rooms: a virtual entry area where the user can choose between 10 different prosthetic case plans of ascending complexity, and a virtual patient case planning room. In spring term 2022, the use of virtual case planning was voluntarily assessed in four different German dental schools (DSs) from the perspective of both lecturers and students. The assessment was performed afterwards using a questionnaire. Data were analysed using Kolmogorov-Smirnov test, exploratory data analysis, Fisher-Freeman-Halton test, and exact Fisher test. Reliability was assessed with Cronbach Alpha test (α < 0.05).

RESULTS

A total of 59 lecturers and 63 students were included. There were 38.5% male, 60.7% female, and 0.8% diverse participants. The mean age of the lecturers was 36.2 ± 9.0 years and of the students 24.3 ± 3.0 years. The VCPE was assessed as good, yet the evaluations between either the DSs or between the lecturers and students were significantly different.

CONCLUSIONS

Even though for some assessment criteria significantly different results between the four DS were observed, the majority of participants evaluated the VCPE positively and recommended them for teaching. The virtual reality as a teaching method for teaching prosthetic case planning for the further preparation of the students for the later professional life can be considered as helpful.

Impact of a virtual prosthetic case planning environment on perceived immersion, cognitive load, authenticity and learning motivation in dental students

INTRODUCTION

The application of virtual reality (VR) presents a big trend in medical education. The aim of this investigation was the presentation and assessment of a multi-user virtual prosthetic case planning environment using criteria such as perceived immersion, cognitive load, authenticity and students´ learning motivation during a virtual seminar.

MATERIALS AND METHODS

The virtual case planning environment consisted of two different virtual environments - the entrance area and the case planning environment. Students and lecturers visited it with the used VR glasses Oculus Quest 2 (Meta Quest). All participants appeared as tooth avatars (molars) during the prosthetic case planning seminar and were able to communicate. These voluntary virtual case planning seminars took place in the clinical prosthetic courses (4th and 5th year). Students were asked to fill in the questionnaire comprising 15 questions separated into four categories, each assessed by a 11-point Likert scale: perceived presence/immersion, cognitive load, motivation and authenticity. A negative and a positive focus group were built, each consisting of three students answering three guiding questions. An exploratory data analysis was performed with the significance level set at p = .05.

RESULTS

A total of 64 students out of 98 participated in the virtual seminars. The results demonstrated that the students felt very comfortable in the virtual seminar environment and were able to focus well on the content, demonstrated in predominantly positive results for presence/immersion. Cognitive load and authenticity presented positive results. In particular, the motivation of the students showed a high score (median: 2.1-2.6; IQR: 3.9). The cognitive load should be reduced if necessary to increase focus. The cyber sickness is a challenge for some students as well as the technical requirements of the internet connection, which needs to be addressed. Nevertheless, virtual case planning seminars are an essential tool for motivating the new generation of students.

CONCLUSIONS

The results of the investigation demonstrate that the students felt very comfortable in the virtual seminar environment and were able to focus well on the content. The prosthetic case plannings were well understood and the students quickly become familiar with the environment. The cognitive load could be reduced to increase focus. In particular, the motivation of the students showed a high score. The cyber sickness is a challenge for some students as well as the technical requirements of the internet connection, which needs to be addressed.

Lessons for Medical and Health Education Learned from the COVID-19 Pandemic

Our paper analyzes lessons for medical education and health education stemming from the experience gained in the course of the COVID-19 pandemic. Moreover, it tackles the issue of the social health and psychological wellbeing of medical students involved in online education during the COVID-19 pandemic. The paper systematizes up-to-date data on how medical schools and universities have adapted to the conditions of the COVID-19 pandemic and implemented novel effective solutions for the learning process, such as transitioning from traditional in-person classes to online learning, incorporating virtual simulations and telemedicine experiences for clinical training, and collaborating with health authorities to provide support in testing and contact tracing efforts. The paper contains an analysis of various aspects of medical education, such as the changes in practical classes, the impact of the pandemic on the formation of communication skills, methods for assessing students' knowledge and skills, and many others. It also considers case studies related to the implementation of educational programs, methodologies, and novel digital technologies in a pandemic. Additionally, the paper features an empirical study that is based on the results of our own survey that was carried out with the help of a snowball convenient sampling that involved 710 medical students between 19 and 25 years of age (56% females and 44% males) from 4 Russian regions (Moscow, Krasnodar, Kazan, and Saint Petersburg). We applied the correlation between stress scores, anxiety scores, factors of stress, and strategies for coping with stress and various economic and demographic variables (age, environment, and gender) that were analyzed using the chi-square test. Our results demonstrate that over 85% of the students in our sample yielded an above-average vulnerability to stress due to the COVID-19 restrictions. At the same time, around 61% of the students experienced severe anxiety during online education in the COVID-19 pandemic. The important factors leading to stress and anxiety were the fear of getting infected and social distancing, and the best strategy to deal with stress and increase wellbeing was self-control. Through a comprehensive review of the literature and empirical estimations, our paper identifies key areas of improvement, including curriculum adaptation, technology integration, faculty development, student support, and interprofessional collaboration. The proposed recommendations aim at strengthening medical education systems and preparing healthcare professionals to effectively navigate future pandemics.

Participant Perceptions of Augmented Reality Simulation for Cardiac Anesthesiology Training: A Prospective, Mixed-Methods Study

Background

Simulations are a critical component of anesthesia education, and ways to broaden their delivery and accessibility should be studied. The primary aim was to characterize anesthesiology resident, fellow, and faculty experience with augmented reality (AR) simulations. The secondary aim was to explore the feasibility of quantifying performance using integrated eye-tracking technology.

Methods

This was a prospective, mixed-methods study using qualitative thematic analysis of user feedback and quantitative analysis of gaze patterns. The study was conducted at a large academic medical center in Northern California. Participants included 7 anesthesiology residents, 6 cardiac anesthesiology fellows, and 5 cardiac anesthesiology attendings. Each subject participated in an AR simulation involving resuscitation of a patient with pericardial tamponade. Postsimulation interviews elicited user feedback, and eye-tracking data were analyzed for gaze duration and latency.

Results

Thematic analysis revealed 5 domains of user experience: global assessment, spectrum of immersion, comparative assessment, operational potential, and human-technology interface. Participants reported a positive learning experience and cited AR technology's portability, flexibility, and cost-efficiency as qualities that may expand access to simulation training. Exploratory analyses of gaze patterns suggested that trainees had increased gaze duration of vital signs and gaze latency of malignant arrythmias compared with attendings. Limitations of the study include lack of a control group and underpowered statistical analyses of gaze data.

Conclusions

This study suggests positive user perception of AR as a novel modality for medical simulation training. AR technology may increase exposure to simulation education and offer eye-tracking analyses of learner performance.

The effect of virtual reality on cognitive, affective, and psychomotor outcomes in nursing staffs: systematic review and meta-analysis

BACKGROUND

In the healthcare systems of the world, reinforcing the competence and professionalism of nurses has become a concern. Gaining clinical nursing competence in the healthcare system requires more effort, and additional training is required. Medical education and training have begun using digital technologies, such as virtual reality (VR). The purpose of this research was to examine the efficacy of VR in terms of cognitive, emotional, and psychomotor outcomes and learning satisfaction in nurses.

METHOD

The study searched eight databases (Cochrane library, EBSCOHost, Embase, OVID MEDLINE, ProQuest, PubMed, Scopus, and Web of Science) for articles that met these criteria: (i) nursing staff, (ii) any virtual reality technology intervention for education, all levels of immersion, [1] randomized control trial and quasi-experiment study, and (iv) published articles and unpublished theses. The standardized mean difference was measured. The random effect model was applied to measure the main outcome of the study with a significance level of p < .05. The I² statistic assessment was applied to identify the level of heterogeneity of the study.

RESULTS

A total of 6740 studies were identified, of which 12 studies with 1470 participants met the criteria for inclusion. The meta-analysis showed a significant improvement in the cognitive aspect (standardized mean difference [SMD] = 1.48; 95% CI = 0.33-2.63; p = .011, I² = 94.88%), the affective aspect (SMD = 0.59; 95% CI = 0.34-0.86; p < .001, I² = 34.33%), the psychomotor aspect (SMD = 0.901; 95% CI = 0.49-1.31; p < .001, I² = 80.33%), and learning satisfaction (SMD = 0.47; 95% CI = 0.17-0.77; p = .002, I² = 0%) aspects of the groups that received the VR intervention compared to the control groups. Subgroup analysis found that dependent variables (e.g., level of immersion) did not improve study outcomes. The quality of evidence was low which is affected by major methodological issues.

CONCLUSIONS

VR may favorable as alternative method to increase nurse competencies. Randomized controlled trials (RCTs) on larger samples are needed to strengthen the evidence for the effect of VR in various clinical nurse settings. ROSPERO registration number: CRD42022301260.

Remote, asynchronous training and feedback enables development of neurodynamic skills in physiotherapy students

BACKGROUND

During the COVID-19 pandemic, face-to-face teaching and learning of physiotherapy practical skills was limited. Asynchronous, remote training has been effective in development of clinical skills in some health professions. This study aimed to determine the effect of remote, asynchronous training and feedback on development of neurodynamic skills in physiotherapy students.

METHODS

Longitudinal repeated measurements study, across four training sessions. Participants engaged in a remote training program for development of upper limb neurodynamic techniques. In this sequential training, participants viewed the online tutorial, practiced independently, and uploaded a video of their performance for formative assessment and feedback from a trained instructor via a checklist and rubric.

RESULTS

Intra-subject analyses of 60 third-year physiotherapy students showed that the target standard of performance, with no further significant change in scores, was attained following session 2 for the checklist and session 3 for the rubric. This shows that two sessions are required to learn the procedures, and three sessions yield further improvements in performance quality.

CONCLUSION

The remote, asynchronous training and feedback model proved to be an effective strategy for students' development of neurodynamic testing skills and forms a viable alternative to in-person training. This study contributes to the future of acquiring physiotherapy clinical competencies when distance or hybrid practice is required.

A Qualitative Study of Medical Students' Perspectives on Distance Learning During COVID-19

Introduction

With the Coronavirus disease 2019 [COVID-19] pandemic, changes were undertaken out of necessity to allow medical students to continue their education. The aim of this study is to create key themes for educators to consider when implementing distance learning strategies into the curriculum based on 2nd year graduate entry medical students experience of learning and engagement with the use of distance learning during the COVID-19 pandemic.

Materials and Methods

A qualitative study with a phenomenological methodology was set within a constructivist paradigm. A volunteer sampling strategy was used to recruit participants. Nine semi-structured, audio-recorded interviews were undertaken and transcribed verbatim. A thematic analysis was undertaken of the transcripts using the Braun and Clarke framework with an open-coded approach.

Results

Exploration of the student experience generated an understanding of the learning process. The concept of adaptability emerged based on the themes of technology, environment, study skills and human interaction.

Discussion

Necessary changes to the formal curriculum affected medical students learning and experience that demanded adaptability. The 'new normal' generated a context within which students were communicating and interacting in ways creating individual challenges for students and educators.

Conclusion

With the advancements in information, communication and technology, distance learning is likely to be further incorporated in undergraduate training long term. Its position should be one that is harmonious within the wider educational realm that engages and meets the needs of the students. The rich understanding exposes adaptations and considerations for educators to improve the student experience.

OrthoACCESS: Implementing a Sub-Internship Curriculum for MS4s Applying to Orthopaedic Surgery

OBJECTIVE

Medical students pursuing orthopedic surgery residency build foundational knowledge during clinical rotations. Most clinical rotations, home and away, were paused during the COVID-19 pandemic. Given the lack of structured fourth-year medical student (MS4) education for basic orthopedics, educators developed the Ortho Acting-Intern Coordinated Clinical Education and Surgical Skills (OrthoACCESS) curriculum in 2019. This study demonstrates the accessibility and usability of a MS4 virtual orthopedic curriculum and examines the curriculum's role in increasing learner familiarity with basic orthopedic topics in 2020.

DESIGN

OrthoACCESS faculty presented weekly lectures from July to October 2020 using Zoom Webinar. Website content included recorded webinars, external resources, and skills videos. Registrants were anonymously surveyed after each webinar characterizing the knowledge and utility of individual lectures. After the webinar series, registrants were emailed an anonymous post-curriculum survey characterizing their experience using the OrthoACCESS curriculum.

RESULTS

OrthoACCESS had 1062 registrants, with 59% (624/1,062) MS4s. 4528 users accessed the OrthoACCESS website from 66 countries. The 15 lectures were viewed 3743 times, 1553 live views and 2190 asynchronous views. 444 postwebinar surveys were completed. Weekly response rates ranged from 18% to 45%. Respondents felt more knowledgeable and more able to apply their knowledge after viewing each lecture (p < 0.001), and found the webinars to be well-organized, well-paced, enthusiastically taught, and level-appropriate. 122/976 (13%) students and 45/291 (15%) faculty completed the postcurriculum survey. Faculty reported that OrthoACCESS was "quite useful" (4 [3-5]) for providing knowledge for an incoming orthopaedic intern. Faculty and students would recommend OrthoACCESS to future learners (5 [4-5]).

CONCLUSIONS

OrthoACCESS delivered foundational musculoskeletal instruction during a period of increased need. In its initial iteration, this virtual curriculum demonstrated high utilization in the United States and internationally and improved participants' self-reported topical knowledge and ability to apply it clinically.

Development and Implementation of a Virtual Clinical Skills Examination in General Psychiatry

OBJECTIVE

During the COVID-19 pandemic, psychiatry programs have administered the Clinical Skills Evaluation (CSE) through videoconferencing. The authors evaluated the feasibility and appropriateness of administering virtual CSEs.

METHODS

Virtual CSEs were administered to 11 general psychiatry residents on March 16, 2021. Teleconference software was used to connect faculty at work sites, residents at a simulation center, and volunteer patients at home. Before and after the CSE, residents and faculty were surveyed with Likert scale questions to evaluate their perceptions and experience.

RESULTS

All virtual CSEs were completed successfully. Nine residents (82%) and 12 faculty (92%) responded to both surveys. Most participants (range, 67-83%) indicated that the virtual CSE was appropriate for assessing patient health and resident skills. Most participants (range, 56-100%) reported that the opening and closing of the interview, informational and affective cues, and rapport were adequately assessed. All participants agreed that suicidal and homicidal risks could be adequately assessed. Most faculty and residents (76%) believed that unique skills were required for telehealth interviews. Before the CSE, more faculty than residents believed that they received adequate training for the virtual CSE (P=.02); afterward, most participants thought that training was adequate (P=.46). More faculty than residents reported increased convenience with virtual assessments (both surveys, P<.01).

CONCLUSION

Virtual CSEs were deemed feasible and appropriate. Further research is needed to identify the specific skills required to perform a virtual CSE and to clarify the potential limitations and benefits of this format.

Static and Dynamic Accuracy and Occlusion Robustness of SteamVR Tracking 2.0 in Multi-Base Station Setups

The tracking of objects and person position, orientation, and movement is relevant for various medical use cases, e.g., practical training of medical staff or patient rehabilitation. However, these demand high tracking accuracy and occlusion robustness. Expensive professional tracking systems fulfill these demands, however, cost-efficient and potentially adequate alternatives can be found in the gaming industry, e.g., SteamVR Tracking. This work presents an evaluation of SteamVR Tracking in its latest version 2.0 in two experimental setups, involving two and four base stations. Tracking accuracy, both static and dynamic, and occlusion robustness are investigated using a VIVE Tracker (3.0). A dynamic analysis further compares three different velocities. An error evaluation is performed using a Universal Robots UR10 robotic arm as ground-truth system under nonlaboratory conditions. Results are presented using the Root Mean Square Error. For static experiments, tracking errors in the submillimeter and subdegree range are achieved by both setups. Dynamic experiments achieved errors in the submillimeter range as well, yet tracking accuracy suffers from increasing velocity. Four base stations enable generally higher accuracy and robustness, especially in the dynamic experiments. Both setups enable adequate accuracy for diverse medical use cases. However, use cases demanding very high accuracy should primarily rely on SteamVR Tracking 2.0 with four base stations.

Mobile virtual tooth morphology teaching environment for preclinical dental students

OBJECTIVES

Extended reality as an additional digital learning concept comprises virtual reality (VR), augmented reality, and mixed reality. In particular, VR allows an interaction in the virtual world. The aim of this study was to evaluate the students' attitude toward a mobile VR application for teaching tooth morphologies.

METHODS

Eighty-two first year dental students were enrolled. After using the VR learning environment with mobile VR glasses at home for 1 week, the students were asked to fill in a questionnaire with 21 questions regarding intuitive handling, and supplemental learning information in comparison to the use of conventional textbooks. Nine questions provided predefined answer options, another nine had the form of a visual analog scale (VAS, range 0%-highly negative to 100%-highly positive), and three allowed free text answers. The data were checked for normal distribution (Kolmogorov-Smirnov test) and was analyzed descriptively.

RESULTS

Forty-four percent of the students rated their perception of understanding of dental morphologies much better with VR than with conventional learning. The potential of the VR learning environment for further dental topics was assessed with a median VAS score of 75.8%. Its intuitive handling was evaluated with a median VAS score of 67.1%. The haptic, visual, and auditory supplemental learning information was consistently rated positively with VAS scores of 73.9%, 80.0%, and 71.6%, respectively. Overall, a majority of the students (85.5%) recommended the VR learning environment for dental morphology.

CONCLUSIONS

The VR dental learning environment allows dental students an additional learning opportunity of dental morphologies, recommended by more than 85% of students.

Walking a mile in Grandma’s shoes - medical students’ evaluation of a very simple online aging game to enhance their understanding of older patients

Background

Aging simulation games are established educational interventions to make older patients’ perspectives noticeable, raise awareness about their needs, and positively influence attitudes toward older adults. Due to the COVID-19 pandemic restrictions imposed on education, we replaced a classroom-based aging simulation course with a simple online equivalent. This consisted of short introductory screencasts, four downloadable Portable Document Format (PDF) files containing issue-specific audio and video links, quizzes, case studies, and prompts for reflection. We explored how well our self-directed simple online simulation succeeded in providing students with relevant insights and experiences, raising awareness about age-related difficulties, and enhancing understanding of older patients.

Methods

In this cross-sectional study, an anonymous post hoc online survey was conducted among 277 5th-year medical students eligible for the course at the Leipzig University in May 2020. The questionnaire addressed overall course evaluations, assessments of the individual PDF components (working enjoyment, personal insights, professional learning gain, enhanced understanding, increased interest in working with older patients), and students’ main insights from the course (free text). Descriptive statistical and qualitative content analyses were performed.

Results

The response rate was 92.4% (n = 256, mean age 25.7 ± 3.4 years, 59.8% women). Nearly all respondents reported that the course was well structured, easily understandable, and that processing was intuitive. The majority (82.8%) perceived the course as practice-oriented, 88.3% enjoyed processing, 60.3% reported having gained new professional knowledge, and 75.4% had new personal insights. While only 14.8% agreed that the online course could generally replace the real-world simulation, 71.1% stated that it enabled them to change their perspective and 91.7% reported enhanced understanding of older patients. PDF components containing audio and video links directly imitating conditions (visual or hearing impairment) were rated highest. Qualitative data revealed manifold insights on the part of the students, most frequently referring to aspects of professional doctor-patient interaction, knowledge about conditions and diseases, role reversal, and enhanced empathy.

Conclusion

Simple online aging simulations may be suitable to provide students with relevant insights and enhance their understanding of older patients. Such simulations could be alternatively implemented in health professionals’ education where resources are limited.

Communication Skills Training Using Remote Augmented Reality Medical Simulation: a Feasibility and Acceptability Qualitative Study

INTRODUCTION

Augmented reality (AR) has promise as a clinical teaching tool, particularly for remote learning. The Chariot Augmented Reality Medical (CHARM) simulator integrates real-time communication into a portable medical simulator with a holographic patient and monitor. The primary aim was to analyze feedback from medical and physician assistant students regarding acceptability and feasibility of the simulator.

METHODS

Using the CHARM simulator, we created an advanced cardiovascular life support (ACLS) simulation scenario. After IRB approval, preclinical medical and physician assistant students volunteered to participate from August to September 2020. We delivered augmented reality headsets (Magic Leap One) to students before the study. Prior to the simulation, via video conference, we introduced students to effective communication skills during a cardiac arrest. Participants then, individually and remotely from their homes, synchronously completed an instructor-led ACLS AR simulation in groups of three. After the simulation, students participated in a structured focus group using a qualitative interview guide. Our study team coded their responses and interpreted them using team-based thematic analysis.

RESULTS

Eighteen medical and physician assistant students participated. We identified four domains that reflected trainee experiences: experiential satisfaction, learning engagement, technology learning curve, and opportunities for improvement. Students reported that the simulator was acceptable and enjoyable for teaching trainees communication skills; however, there were some technical difficulties associated with initial use.

CONCLUSION

This study suggests that multiplayer AR is a promising and feasible approach for remote medical education of communication skills during medical crises.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01598-7.

Experience with an OSCE anamnesis station via Zoom: Feasibility, acceptance and challenges from the perspective of students, simulated patients and examiners during the COVID-19 pandemic

Aim: Assessments of practical clinical competencies pose a challenge during the COVID-19 pandemic. Reports about OSCE stations administered online show that, despite technical feasibility and acceptance, there is a lingering desire for in-person assessments. Barriers and challenges must therefore also be identified in regard to the future integration of digital competencies into the curriculum. Based on a study investigating the feasibility and acceptance of an online OSCE anamnesis station and the descriptions given by students, simulated patients and examiners of the challenges and limitations, we make recommendations for necessary future adaptations to anamnesis training and testing in the context of telemedicine. Method: We surveyed students after completion of an OSCE anamnesis station, adapted to the telemedical setting, that was administered as an alternative assessment to 149 students via Zoom^®. Using semi-structured interviews, we analyzed the resulting challenges and limitations as seen by all of the participants. Results: We confirm the existence of good technical and organizational feasibility, positive learning experiences through feedback, the acquisition of clinical competencies, and a high acceptance of this format as an alternative assessment during the pandemic. Using the semi-structured interviews, it was also possible to analyze additional categories that identify necessary adaptations of this type of format. Conclusion: Adaptation of the content-based training for all of the participants and a targeted revision of the checklists, e.g., regarding communication techniques in a telemedicine setting, is required due to the effects of the online format on communication and interactions between students and simulated patients.

Professional motivations and perceptions of senior dental students in the distance education period during the first year of the Covid-19 pandemic

Purpose

Dental students are particularly prone to be affected by the global emergency of Coronavirus-19 (Covid-19) pandemic. The aim of this study was to evaluate the professional motivations and perceptions of senior dental students during the distance education period due to pandemic.

Materials and methods

The data was collected via an online questionnaire, including questions related to students' professional motivation and perceptions, and views about preventive dentistry. For identifying the distress levels, Turkish version of Depression Anxiety Stress Scale (DASS)-21 was used. Descriptive statistics and marginal homogeneity test were used for statistical analysis.

Results

A total of 114 (83 female, 31 male) students, with the mean age of 23.7±1.03 participated the study. Statistically significant changes were observed on the students' career plans (p<0.001); fear about getting and transmitting infectious diseases (p<0.001); and satisfaction about their profession (p<0.001) during the Covid-19 pandemic. Motivation loss was determined on the participants.

Conclusion

There is an urgent need for revision on dental education in order to ensure the students be competent to provide oral health service that can meet the latest needs and achieve professional self-confidence without deterioration on their professional motivation and perceptions. Crisis-oriented psychological support programs should be provided for students. Some improvements should be structured in terms of preventive dentistry issues, both for dental education and dental health service aspects.

Sustainable Distance Online Educational Process for Dental Students during COVID-19 Pandemic

In this study, we evaluated the perception of distance online learning in undergraduate dental students in two different European countries during the second lockdown of the COVID-19 pandemic to explore sustainable undergraduate educational and examination e-learning forms. Dental students from Dental school of Athens, National and Kapodistrian university of Athens (N1_3rd preclinical year = 131, N2_4th clinical year = 119) and Dental school of Copenhagen (3rd preclinical year N3 = 85) completed the mixed-designed Dental e-Learning process Questionnaire (DeLQ) distributed in a google form. Responses to closed-ended questions were collected on a five-point Likert scale. Descriptive statistics were applied, and non-parametric Kruskal–Wallis tests were used to examine student groups. N1 (90% strongly agree) students reported that “e-learning is a suitable education method for theory in dentistry” at a significant level and more often than N2 (43% strongly disagree). N1 and N2 students strongly agreed that they preferred face-to-face teaching rather than distance e-learning. A relatively low number of N1 (31%) students believed that e-learning prepares them sufficiently for their practical training while none of the (0%) N2 cohort agreed. A low percentage of students in both years (N1 = 31%, N2 = 23%) believed that e-learning prepared them for their exams. Additionally, N1 = 60% and N2 = 66% preferred hybrid learning. Only 26% (N1) and 19.5% (N2) desired e-learning to continue after the COVID-19 pandemic. Nearly half of the participants believed the online exam model to be unreliable (N1 = 49%, N2 = 43%). Overall, students considered distance e-learning as an educational method applicable only to theoretical lessons. However, the lack of physical communication and interaction in distance learning led students to prefer a blended method. Students of the two faculties seemed to agree on many points, but there were also specific differences attributable to the differences in the programs and educational culture of the two countries.

Perceived roles, benefits and barriers of virtual global health partnership initiatives: a cross-sectional exploratory study

Background

Virtual global health partnership initiatives (VGHPIs) evolved rapidly during the COVID-19 pandemic to ensure partnership continuity. However the current landscape for VGHPI use and preference is unknown. This study aimed to increase understanding of GH partners’ perspectives on VGHPIs.

Methods

From 15 October to 30 November 2020, An online, international survey was conducted using snowball sampling to document pandemic-related changes in partnership activities, preferences for VGHPIs, and perceived acceptability and barriers. The survey underwent iterative development within a diverse author group, representing academic and clinical institutions, and the non-profit sector. Participants from their professional global health networks were invited, including focal points for global health partnerships while excluding trainees and respondents from the European Economic Area. Analysis stratified responses by country income classification and partnership type. Authors used descriptive statistics to characterize responses, defining statistical significance as α = 0.05.

Results

A total of 128 respondents described 219 partnerships. 152/219 (69%) partnerships were transnational, 157/219 (72%) were of > 5 years duration, and 127/219 (60%) included bidirectional site visits. High-income country (HIC) partners sent significantly more learners to low- to middle-income country (LMIC) partner sites (p < 0.01). Participants commented on pandemic-related disruptions affecting 217/219 (99%) partnerships; 195/217 (90%) were disruption to activities; 122/217 (56%) to communication; 73/217 (34%) to access to professional support; and 72/217 (33%) to funding. Respondents indicated that VGHPIs would be important to 206/219 (94%) of their partnerships moving forward. There were overall differences in resource availability, technological capacity, and VGHPI preferences between LMIC and HIC respondents, with a statistically significant difference in VGHPI acceptability (p < 0.001). There was no significant difference between groups regarding VGHPIs’ perceived barriers.

Conclusions

The pandemic disrupted essential partnership elements, compounding differences between LMIC and HIC partners in their resources and preferences for partnership activities. VGHPIs have the potential to bridge new and existing gaps and maximize gains, bi-directionality, and equity in partnerships during and after COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41256-022-00244-4.

Benefits of Taking a Virtual Field Trip in Immersive Virtual Reality: Evidence for the Immersion Principle in Multimedia Learning

This study describes and investigates the immersion principle in multimedia learning. A sample of 102 middle school students took a virtual field trip to Greenland via a head mounted display (HMD) or a 2D video as an introductory lesson within a 6-lesson inquiry-based climate change intervention. The HMD group scored significantly higher than the video group on presence (d = 1.43), enjoyment (d = 1.10), interest (d = .57), and retention in an immediate (d = .61) and delayed posttest (d = .70). A structural equation model indicated that enjoyment mediated the pathway from instructional media to immediate posttest, and interest mediated the pathway from instructional media to delayed posttest score, indicating that these factors may play different roles in the learning process with immersive media. This work contributes to the cognitive affective model of immersive learning, and suggests that immersive lessons can have positive longitudinal effects for learning.

The impact of the modified schedules of anatomy education on students' performance and satisfaction: Responding to COVID-19 pandemic in South Korea

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic substantially undermined medical education and healthcare systems. Owing to the pandemic in South Korea, most medical schools needed to be flexible when conducting online and offline classes, but the guidelines did not reflect the specificity of medical schools. This study described the impact of modified anatomy education schedules at the Seoul National University College of Medicine (SNUCM) on students' academic performance and satisfaction.

METHODS

Anatomy education in SNUCM is divided into three regional units (the upper and lower limbs, trunk, and head and neck). Owing to the COVID-19 pandemic, the schedule was mixed with simultaneous and rotating schedules. The authors conducted exceptions for online lectures, cadaver dissections, and written and practical examinations in three classes of approximately 50 students each. Furthermore, the authors assessed students' performance using three sets of written and practical examinations, and students completed a questionnaire regarding modified anatomy laboratory schedules.

RESULTS

Despite the pandemic events in Seoul and South Korea during the laboratory sessions, all sessions were completed without any confirmed COVID-19 cases among the students, faculty, and staff. Most of the scores on the written and practical examinations significantly decreased in 2020 compared to those in 2019. However, in the trunk session that used the virtual anatomy application, the score on the practical examination in 2020 was significantly higher than that in 2019. Over 70% (79 and 77 out of 105 respondents on the upper and lower limbs and trunk, respectively) and 53% (55/105) students reported that there were no significant difficulties in studying anatomy in a face-to-face laboratory.

CONCLUSIONS

In conclusion, an adequate education program for cadaver dissection should be developed and provided to overcome the pandemic restrictions. The study findings could serve as a reference for anatomy education during the COVID-19 pandemic.

Using Technology Adoption Theories to Maximize the Uptake of E-learning in Medical Education

INTRODUCTION

While the use of e-learning tools in medical education is guided by robust literature on their design and evaluation, there is sparse literature on strategies that maximize their adoption among trainees.

METHODS

In this scoping review, we searched Web of Science for studies on technology adoption theories as applied to education, using a final censoring date of August 1, 2021.

RESULTS

Based on our findings, we identified three representative theories: (1) technology acceptance model, (2) technology adoption life cycle, and (3) domestication theory.

DISCUSSION

We describe these theories in detail, examine their prior applications, and propose specific uses within medical e-learning.

Virtual Simulation in Undergraduate Medical Education: A Scoping Review of Recent Practice

Virtual simulation (VS) as an emerging interactive pedagogical strategy has been paid more and more attentions in the undergraduate medical education. Because of the fast development of modern computer simulation technologies, more and more advanced and emerging VS-based instructional practices are constantly increasing to promote medical education in diverse forms. In order to describe an overview of the current trends in VS-based medical teaching and learning, this scoping review presented a worldwide analysis of 92 recently published articles of VS in the undergraduate medical teaching and learning. The results indicated that 98% of included articles were from Europe, North America, and Asia, suggesting a possible inequity in digital medical education. Half (52%) studies reported the immersive virtual reality (VR) application. Evidence for educational effectiveness of VS in medical students’ knowledge or skills was sufficient as per Kirkpatrick’s model of outcome evaluation. Recently, VS has been widely integrated in surgical procedural training, emergency and pediatric emergency medicine training, teaching of basic medical sciences, medical radiation and imaging, puncture or catheterization training, interprofessional medical education, and other case-based learning experiences. Some challenges, such as accessibility of VS instructional resources, lack of infrastructure, “decoupling” users from reality, as well as how to increase students’ motivation and engagement, should be addressed.

One year of anatomy teaching and learning in the outbreak: Has the Covid-19 pandemic marked the end of a century-old practice? A systematic review

At the end of 2019, the Covid-19 pandemic spread caused restrictions in business and social spheres. Higher education was also severely affected: universities and medical schools moved online to distance learning and laboratory facilities closed. Questions arise about the long-term effects of this pandemic on anatomical education. In this systematic review, the authors investigated whether or not anatomical educators were able to deliver anatomical knowledge during this pandemic. They also discuss the challenges that anatomical education has faced over the last year. The search strategy was conducted between July 2020 and July 2021. Two hundred and one records were identified, and a total of 79 studies were finally included. How best to deliver anatomy to students remains a moot point. In the last years, the advent of new technologies has raised the question of the possible overcoming of dissection as the main instrument in anatomical education. The Covid-19 pandemic further sharpened the debate. Remote learning enhanced the use of technologies other than cadaveric dissection to teach anatomy. Moreover, from the analyzed records it appears that both from students' perspective as well as teachers' there is a clear tear between those who endorse dissection and those who believe it could be easily overcome or at least integrated by virtual reality and online learning. The authors strongly believe that the best anatomy teaching practice requires the careful adaptation of resources and methods. Nevertheless, they support cadaveric dissection and hope that it will not be replaced entirely as a result of this pandemic.

Medical Undergraduate Students’ Perception about Online Education during the COVID-19 Pandemic

BACKGROUND: The influence of the COVID-19 pandemic is great not only on general health but also on regular learning worldwide. AIM: This study analyzed medical undergraduate students’ feedback about online education at Taif University during the COVID-19 pandemic. METHODS: Five hundred undergraduate medical students from the four medical colleges at Taif University participated in the current study. They were requested to give their feedback about online medical education through an online questionnaire. The questionnaire was prepared and administered to the medical students at different academic levels through Google forms. The current study is a cross-sectional study. RESULTS: The respondents who can ask questions during e-classes were significantly higher than those who had not this opportunity. A significantly higher number of students reported that the shared material was useful. In addition, the study results indicated significantly poor student-teacher interaction during the e-classes. Finally, about 231 of the respondents (46.2%) preferred physical classes over e-classes and 140 of respondents (28%) preferred online classes over physical classes, and the remaining number, 129 (25.8%), mentioned that online and conventional education are both the same. CONCLUSION: Most students said that conventional education is better than online education. The combination of online and formal education can be implemented after the COVID-19 pandemic to satisfy all parties.

Learning Outcomes of Immersive Technologies in Health Care Student Education: Systematic Review of the Literature

BACKGROUND

There is a lack of evidence in the literature regarding the learning outcomes of immersive technologies as educational tools for teaching university-level health care students.

OBJECTIVE

The aim of this review is to assess the learning outcomes of immersive technologies compared with traditional learning modalities with regard to knowledge and the participants' learning experience in medical, midwifery, and nursing preclinical university education.

METHODS

A systematic review was conducted according to the Cochrane Collaboration guidelines. Randomized controlled trials comparing traditional learning methods with virtual, augmented, or mixed reality for the education of medicine, nursing, or midwifery students were evaluated. The identified studies were screened by 2 authors independently. Disagreements were discussed with a third reviewer. The quality of evidence was assessed using the Medical Education Research Study Quality Instrument (MERSQI). The review protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews) in April 2020.

RESULTS

Of 15,627 studies, 29 (0.19%) randomized controlled trials (N=2722 students) were included and evaluated using the MERSQI tool. Knowledge gain was found to be equal when immersive technologies were compared with traditional learning modalities; however, the learning experience increased with immersive technologies. The mean MERSQI score was 12.64 (SD 1.6), the median was 12.50, and the mode was 13.50. Immersive technology was predominantly used to teach clinical skills (15/29, 52%), and virtual reality (22/29, 76%) was the most commonly used form of immersive technology. Knowledge was the primary outcome in 97% (28/29) of studies. Approximately 66% (19/29) of studies used validated instruments and scales to assess secondary learning outcomes, including satisfaction, self-efficacy, engagement, and perceptions of the learning experience. Of the 29 studies, 19 (66%) included medical students (1706/2722, 62.67%), 8 (28%) included nursing students (727/2722, 26.71%), and 2 (7%) included both medical and nursing students (289/2722, 10.62%). There were no studies involving midwifery students. The studies were based on the following disciplines: anatomy, basic clinical skills and history-taking skills, neurology, respiratory medicine, acute medicine, dermatology, communication skills, internal medicine, and emergency medicine.

CONCLUSIONS

Virtual, augmented, and mixed reality play an important role in the education of preclinical medical and nursing university students. When compared with traditional educational modalities, the learning gain is equal with immersive technologies. Learning outcomes such as student satisfaction, self-efficacy, and engagement all increase with the use of immersive technology, suggesting that it is an optimal tool for education.

Evaluation of the online learning of veterinary anatomy education during the Covid-19 pandemic lockdown in Egypt: Students' perceptions

The sudden shift of veterinary anatomy teaching from traditional to online mode during the coronavirus disease 2019 (Covid-19) pandemic lockdown was a major challenge used for the first time in Egyptian veterinary medical schools. This study aimed to evaluate the students' perspectives regarding the shift of veterinary anatomy teaching to online mode during the lockdown in Egypt. A total of 502 students from all veterinary medical schools in Egypt (n = 17) answered the questionnaire. The results revealed that nearly two-thirds of students felt enthusiastic about studying anatomy online during the pandemic. Moreover, approximately 63% of students were satisfied with the provided learning materials, 66% were able to understand anatomy using the online learning system during the lockdown period, 67% were comfortable with technological skills during their online study, and 47% believed that online learning of anatomy could replace face-to-face teaching. Therefore, despite the problems associated with the emergency switch to remote teaching, it appears to be a suitable alternative in teaching veterinary anatomy in Egyptian universities during this pandemic crisis in Egyptian universities. Moreover, the study provided several measurements to overcome the common problems associated with this challenging method for future application, such as providing three-dimensional virtual tools and electronic devices with either free or low-priced Internet packages, and measuring students' understanding before and after each lecture. This is the first study to solicit the early students' feedback regarding the emergency shift to online veterinary anatomy teaching which might help decision-makers in Egypt for future implementation of online learning of veterinary anatomy.

Virtual dental teaching and its effect on test success - A cross-over study

OBJECTIVES

The aim of this cross-over investigation was to analyze the effect of virtual teaching using virtual reality (VR) within a dental learning environment by preclinical students with or without dental professional experience on test performance.

METHODS

Preclinical students (N = 82) were randomly divided into two groups for cross-over testing of tooth morphology knowledge: (a) anterior VR-group (group 1) using the VR-glasses as an additional learning tool for the anterior tooth morphologies and (b) posterior VR-group (group 2) using it for the posterior tooth morphologies also in addition to conventional learning. All students used the VR-glasses for 1 week independent of time and location depending on group. The students had to recognize teeth (anterior or posterior within two separate tests after three [anterior test] and 6 weeks [posterior test] of practical course) and note the tooth number and characteristics in written form. Former dental experience (dental technician/assistance) was noted. Test results were analyzed to quantify the effect of virtual teaching on test scores. Data were analyzed with the Kolmogorov-Smirnov and Mann-Whitney U test (p = 0.05).

RESULTS

By differentiating the two student groups (use of VR glasses for anterior/posterior teeth) within the dental experience group, significantly better test results (p = 0.040) were shown for group 1 in the total posterior teeth test score. Furthermore, no other significant differences, but a possible tendency, in the test results and thus no effect of the use of the VR glasses on both VR groups could be analyzed (p ≥ 0.051).

CONCLUSIONS

Using the VR tooth learning environment predominantly did not lead to a significant improvement of test results. Anterior teeth test scores predominantly showed significantly better results than posterior teeth test scores.

Pedagogy and innovative care tenets in COVID-19 pandemic: An enhancive way through Dentistry 4.0

The global oral healthcare sector has now woken to implement Dentistry 4.0. The implementation of this revolution is feasible with extensive digital and advanced technologies applications and the adoption of new sets of processes in dentistry & its support areas. COVID-19 has bought new challenges to dental professionals and patients towards their customised requirements, regular dental health checkups, fast-paced and safe procedures. People are not visiting the dentist even for mild cases as they fear COVID-19 infection. We see that this set of technologies will help improve health education and treatment process and materials and minimise the infection. During the COVID-19 pandemic, there is a need to understand the possible impact of Dentistry 4.0 for education and innovative care. This paper discusses the significant benefits of Dentistry 4.0 technologies for the smart education platform and dentistry treatment. Finally, this article identifies twenty significant enhancements in dental education and effective care platforms during the COVID-19 pandemic by employing Dentistry 4.0 technologies. Thus, proper implementation of these technologies will improve the process efficiency in healthcare during the COVID-19 pandemic. Dentistry 4.0 technologies drive innovations to improve the quality of internet-connected healthcare devices. It creates automation and exchanges data to make a smart health care system. Therefore, helps better healthcare services, planning, monitoring, teaching, learning, treatment, and innovation capability. These technologies moved to smart transportation systems in the hospital during the COVID-19 Pandemic. Modern manufacturing technologies create digital transformation in manufacturing, optimises the operational processes and enhances productivity.

Innovation and Inequality: A Medical Student Perspective. Comment on "The Present and Future Applications of Technology in Adapting Medical Education Amidst the COVID-19 Pandemic"

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Extended Reality for Enhanced Telehealth During and Beyond COVID-19: Viewpoint

The COVID-19 pandemic caused widespread challenges and revealed vulnerabilities across global health care systems. In response, many health care providers turned to telehealth solutions, which have been widely embraced and are likely to become standard for modern care. Immersive extended reality (XR) technologies have the potential to enhance telehealth with greater acceptability, engagement, and presence. However, numerous technical, logistic, and clinical barriers remain to the incorporation of XR technology into telehealth practice. COVID-19 may accelerate the union of XR and telehealth as researchers explore novel solutions to close social distances. In this viewpoint, we highlight research demonstrations of XR telehealth during the COVID-19 pandemic and discuss future directions to make XR the next evolution of remote health care.

The co.LAB Generic Framework for Collaborative Design of Serious Games: Development Study

Background

Serious games are increasingly used at all levels of education. However, research shows that serious games do not always fulfill all the targeted pedagogical objectives. Designing efficient and engaging serious games is a difficult and multidisciplinary process that requires a collaborative approach. Many design frameworks have been described, most of which are dedicated to the development of specific types of serious games and take the collaborative dimension into account only to a limited extent.

Objective

Our aim was to create a generic serious game design framework that could be adapted to all kinds of serious games and implemented in a collaborative web platform.

Methods

We combined the results of a literature review with our experience in serious game design and development to determine the basic building blocks of a collaborative design framework. We then organized these building blocks into categories and determined the features that a generic design framework should include. Finally, based on the paradigm of complex systems and systemic modelling, we created the co.LAB generic design framework and specifications to allow its implementation in a collaborative web platform.

Results

Based on a total of 10 existing design methodologies or frameworks, 23 building blocks were identified and represent the foundation of the co.LAB framework. These blocks were organized into 5 categories: “context and objectives,” “game design,” “mechanics,” “learning design,” and “assessment.” The arrangement by categories provides a structure that can be visualized in multiple and complementary ways. The classical view links game and learning design while other views offer project, systemic, and process visualizations. For the implementation of the co.LAB framework in a web platform, we propose to convert the building blocks into “cards.” Each card would constitute a collaborative working space for the design of the corresponding block. To make the framework adaptive, cards could be added, adapted, or removed according to the kind of serious game intended. Enhancing the visualization of relationships between cards should support a systemic implementation of the framework.

Conclusions

By offering a structured view of the fundamental design elements required to create serious games, the co.LAB framework can facilitate the design and development of such games by virtue of a collaborative, adaptive, and systemic approach. The different visualizations of the building blocks should allow for a shared understanding and a consistent approach throughout the design and development process. The implementation of the co.LAB framework in a collaborative web platform should now be performed and its actual usability and effectiveness tested.

A COVID-19 Pandemic Sustainable Educational Innovation Management Proposal Framework

The COVID-19 pandemic has promoted a big change in the educational sector. Suddenly, teachers, professors, and students had to migrate from presential classes to the online system without prior notice or a training course. This paper aimed to verify how the need of a rapid change to the online system in response to the impossibility of keeping the presential system due to the mandatory social distancing imposed by the COVID-19 pandemic has affected relationships and performance of teachers, professors, and students, as well as review the technologies and procedures adopted by them to innovate and achieve sustainable education. To address the empirical side of this exploratory research, the authors of this paper sent an email questionnaire to kindergarten, elementary and high school teachers in the City of Rio de Janeiro (Brazil), as well as to professors of the top 197 Brazilian universities. To address theoretical side of this exploratory research, an investigation was carried out through scientific databases. The data were analyzed with SPSS (Statistical Package for the Social Sciences), version 22.0, and with Microsoft Excel 2007. As a result, this paper showed that social isolation and transition to the online system greatly affected the work conditions of teachers and professors, as well as the learning process of students. Anyway, sustainable actions were taken to overcome these challenges. Furthermore, this paper proposed a framework that might support the development of new studies, filling the literature gap on the subject.

Live streaming ward rounds using wearable technology to teach medical students: a pilot study

Background

The COVID-19 pandemic resulted in a loss of clinical clerkship opportunities for medical students. To address this problem while maintaining patient safety, this pilot study explored the feasibility of using a wearable headset to live stream teaching ward rounds to remotely based medical students.

Methods

Three live streamed teaching ward rounds were delivered to three groups of medical students (n=53) using the Microsoft HoloLens 2 device and Microsoft Teams software, and results pooled for analysis. Feedback was gathered from students and instructors using the evaluation of technology-enhanced learning materials (ETELM). Patient feedback was gathered using the Communication Assessment Tool to explore any impact on interpersonal communication.

Results

The response rate for the ETELM-learner perceptions was 58% (31/53), 100% for the ETELM-instructor perceptions. Students strongly agreed that the overall quality of the teaching session and instructors was excellent. However, 32% experienced issues with audio or video quality and one remote student reported cyber sickness. The statement 'educational activities encouraged engagement with session materials/content' returned the most varied response. Instructors reported technological problems with delivery while using the HoloLens 2 device and environmental noise in the ward was a disruptive factor. Preparation and skilled facilitation were key to delivering a high-quality teaching session. Patients reacted generally favourably to the technology and no negative effects on interpersonal communication were identified.

Conclusion

The experience of live streamed ward rounds was well received by patients, medical students and teaching faculty. However, there remain limitations to the routine use of HoloLens 2 technology in our setting including steep learning curves, hardware costs and environmental factors such as noise and WiFi connectivity. Live streamed ward rounds have potential postpandemic implications for the judicious use of resources, and the possibility for few educationally minded clinicians to teach at scale in a patient-friendly manner.

Remote Teaching in a Preclinical Phantom Course in Operative Dentistry During the COVID-19 Pandemic: Observational Case Study

BACKGROUND

During the acute COVID-19 pandemic, physical access to the University Medical Center Göttingen was restricted for students. For the first time at our dental school, theoretical knowledge was imparted to students via asynchronous online screencasts and discussed via synchronous video meetings only.

OBJECTIVE

We aimed to assess the acceptance and effectiveness of distance education as a new teaching format for theoretical knowledge within the preclinical course in Operative Dentistry (sixth semester of the undergraduate dental curriculum in Germany).

METHODS

The phantom course comprised distance education (first phase, 11 weeks) and subsequent on-site practical demonstrations and training (second phase, 10 weeks). All theoretical knowledge was taught via online screencasts during distance education (except for the first week, 3 screencasts were uploaded per week resulting in a total of 30 screencasts). Until the end of the term, all students (N=33) were able to view the screencasts for an unlimited number of times. Theoretical knowledge was assessed in a summative examination after practical on-site teaching. Acceptance and effectiveness of the new curriculum and distance education were also measured based on an evaluation survey and students' self-perceived learning outcome, which was compared to the outcome from the two pre-COVID-19 terms.

RESULTS

Each screencast was viewed by a mean of 24 (SD 3.3) students and accessed a mean of 5.6 (SD 1.2) times per user (ie, by students who accessed the respective screencast at least once). During distance education, the number of accesses showed a linear trend over time. During the practical training phase, screencast views declined and increased again prior to the examination. Screencasts covering topics in Cariology, Restorative Dentistry, and Preventive Dentistry were viewed by more students than screencasts covering topics in Endodontology or Periodontology (both P=.047). Examination items in Periodontology showed inferior results compared to the other topics (P<.001). Within the different topics, students' self-perceived learning outcome did not differ from that during the pre-COVID-19 terms. Although most students agreed that the presented screencasts contributed to their learning outcome, pre-COVID-19 term students more strongly felt that lectures significantly contributed to their learning outcome (P=.03).

CONCLUSIONS

Screencasts showed high acceptance and effectiveness among the students but were not used as a learning tool by all students. However, students who viewed the screencasts accessed each screencast more frequently than they could have attended a conventional lecture. Screencast views were mostly due to intrinsic motivation.

Maintaining Momentum in Infant Mental Health Research During COVID-19: Adapting Observational Assessments

Understanding the potential effects of the COVID-19 pandemic on the developing parent-infant relationship is a priority, especially for medically-fragile infants and their caregivers who face distinct challenges and stressors. Observational assessments can provide important insights into parent-child behaviors and relational risk; however, stay-at-home directives and physical distancing measures associated with COVID-19 have significantly limited opportunities for in-person observational parent-infant assessment. To maintain momentum in our research program during the pandemic, we rapidly pivoted to remote, technology-assisted parent-infant observational assessments. In this commentary, we offer a series of strategies and recommendations to assist researchers in adapting observational parent-infant paradigms. We also discuss the benefits, challenges, and limitations of distance-delivered assessments, and offer considerations for clinical service provision and future research during and post the COVID-19 pandemic. .

Self-Management Mobile Virtual Reality Program for Women with Gestational Diabetes

The incidence of type 2 diabetes and gestational diabetes shows an increasing trend worldwide, and women diagnosed with gestational diabetes are more likely to develop type 2 diabetes within 5 years of delivery. This is closely related to lifestyle habits such as dietary intake and physical activity; hence, self-management should be continuously practiced. However, after childbirth, women find it challenging to practice self-management due to physical discomfort and child rearing. Therefore, it is necessary to develop an intervention program that is tailored to the characteristics of each participant and allows them to practice self-health management efficiently without time and space restrictions. This study aimed to develop a self-management mobile virtual reality program and investigate its efficacy in preventing type 2 diabetes after childbirth among women diagnosed with gestational diabetes. Intervention with the self-management mobile virtual reality program was performed for 12 weeks. The data of 57 participants in the experimental group and 62 participants in the control group were analyzed. After 12 weeks, the body weight, body fat, hemoglobin A1c, and fasting glucose were decreased in the experimental group compared with the control group. In addition, the dietary habits and health-promoting lifestyle profile were improved in the experimental group compared with the control group. These findings demonstrated that a self-managed mobile virtual reality program could be used as an intervention method for health promotion. To verify the effectiveness of intervention with the self-management mobile virtual reality program, a follow-up study with a larger number of research subjects should be conducted in the future.

Asynchronous Distance Learning of the National Institutes of Health Stroke Scale During the COVID-19 Pandemic (E-Learning vs Video): Randomized Controlled Trial

BACKGROUND

The COVID-19 pandemic has considerably altered the regular medical education curriculum while increasing the need for health care professionals. Senior medical students are being incrementally deployed to the front line to address the shortage of certified physicians. These students, some of whom will be fast-tracked as physicians, may lack knowledge regarding the initial management of time-critical emergencies such as stroke.

OBJECTIVE

Our aim was to determine whether an e-learning module could improve asynchronous distance knowledge acquisition of the National Institutes of Health Stroke Scale (NIHSS) in senior medical students compared to the traditional didactic video.

METHODS

A randomized, data analyst-blinded web-based trial was conducted at the University of Geneva Faculty of Medicine between April and June 2020. Fifth year medical students followed a distance learning path designed to teach the NIHSS. The control group followed the traditional didactic video created by Patrick Lyden, while the e-learning group followed the updated version of a previously tested, highly interactive e-learning module. The main outcome was the score on a 50-question quiz displayed upon completion of the learning material. The difference in the proportion of correct answers for each specific NIHSS item was also assessed.

RESULTS

Out of 158 potential participants, 88 started their allocated learning path and 75 completed the trial. Participants who followed the e-learning module performed better than those who followed the video (38 correct answers, 95% CI 37-39, vs 35 correct answers, 95% CI 34-36, P<.001). Participants in the e-learning group scored better on five elements than the video group: key NIHSS concepts (P=.02), the consciousness - global item (P<.001), the facial palsy item (P=.04), the ataxia item (P=.03), and the sensory item (P=.04).

CONCLUSIONS

Compared to the traditional didactic video, a highly interactive e-learning module enhances asynchronous distance learning and NIHSS knowledge acquisition in senior medical students.

Dentistry 4.0 technologies applications for dentistry during COVID-19 pandemic

The term, Dentistry 4.0, coincides with Industry 4.0, in which the traditional methods of manufacturing and information are made more precise to enhance process efficiency by using automation and advanced computer technologies. The main of this paper is to discuss the major potential of Dentistry 4.0 technologies in the field of dentistry during Coronavirus (COVID-19) Pandemic. Thereon, Dentistry 4.0 is advancing on its way with the use of advanced technologies in dentistry. Dental healthcare makes an essential part of the overall health of the masses. New technological advancements are essential to make the dentist work quicker, patient comfortable, and process reliable. So, we introduced the concept of Dentistry 4.0 to improve efficiency and impart innovation in dentistry during this pandemic. This paper briefs about the Dentistry 4.0 technologies helpful for the COVID-19 pandemic. Further discusses various issues and challenges in implementing Dentistry 4.0 for dentistry during the COVID-19 pandemic. Finally, the paper identifies and discussed fifteen significant applications of Dentistry 4.0 technologies for dentistry during the COVID-19 pandemic. With the onset of the pandemic, globally, the healthcare sector is taking initiatives to strengthen affordable and high-speed data connectivity. This up-gradation and investment will also help dentists to access patients' data from smaller towns or villages using Dentistry 4.0 technologies. Thus, globally there is the onset of the fourth dentistry revolution, and we understand that this will change the trend of dentistry during and post-COVID-19 Pandemic. Dentistry 4.0 technologies are helpful during the COVID-19 pandemic to create teledentistry, virtual clinical practice and connect all dental devices to improve health conditions. This approach is to help progress towards the integrated capabilities, patient-centric remedies with predicted results in an easier way than the traditional way of the health care industry.

A Serious Game Designed to Promote Safe Behaviors Among Health Care Workers During the COVID-19 Pandemic: Development of "Escape COVID-19"

BACKGROUND

As many countries fear and even experience the emergence of a second wave of COVID-19, reminding health care workers (HCWs) and other hospital employees of the critical role they play in preventing SARS-CoV-2 transmission is more important than ever. Building and strengthening the intrinsic motivation of HCWs to apply infection prevention and control (IPC) guidelines to avoid contaminating their colleagues, patients, friends, and relatives is a goal that must be energetically pursued. A high rate of nosocomial infections during the first COVID-19 wave was detected by IPC specialists and further cemented their belief in the need for an engaging intervention that could improve compliance with COVID-19 safe behaviors.

OBJECTIVE

Our aim was to develop a serious game that would promote IPC practices with a specific focus on COVID-19 among HCWs and other hospital employees.

METHODS

The first 3 stages of the SERES framework were used to develop this serious game. A brainswarming session between developers and IPC specialists was used to identify the target audience and acquisition objectives. Nicholson's RECIPE mnemonic (reflection, engagement, choice, information, play, exposition) for meaningful gamification was used to guide the general design. A common and simple terminology was used to suit the broad target audience. The game was tested on various platforms (smartphones, tablets, laptops, desktop computers) by different users during each development loop and before its final release.

RESULTS

The game was designed to target all hospital staff who could be in direct contact with patients within the Geneva University Hospitals. In total, 10 acquisition objectives were defined by IPC specialists and implemented into the game according to the principles of meaningful gamification. A simple storyboard was first created using Microsoft PowerPoint and was progressively refined through multiple iteration loops. Articulate Storyline was then used to create two successive versions of the actual game. In the final version, a unique graphic atmosphere was created with help from a professional graphic designer. Feedback mechanisms were used extensively throughout the game to strengthen key IPC messages.

CONCLUSIONS

The SERES framework was successfully used to create "Escape COVID-19," a serious game designed to promote safe IPC practices among HCWs and other hospital employees during the COVID-19 pandemic. This game can be obtained free of charge for research and educational purposes. A SCORM (shareable content object reference model) package is available to facilitate results and completion tracking on most current learning management systems.

Evolution of Bystander Intention to Perform Resuscitation Since Last Training: Web-Based Survey

BACKGROUND

Victims of out-of-hospital cardiac arrest (OHCA) have higher survival rates and more favorable neurological outcomes when basic life support (BLS) maneuvers are initiated quickly after collapse. Although more than half of OHCAs are witnessed, BLS is infrequently provided, thereby worsening the survival and neurological prognoses of OHCA victims. According to the theory of planned behavior, the probability of executing an action is strongly linked to the intention of performing it. This intention is determined by three distinct dimensions: attitude, subjective normative beliefs, and control beliefs. We hypothesized that there could be a decrease in one or more of these dimensions even shortly after the last BLS training session.

OBJECTIVE

The aim of this study was to measure the variation of the three dimensions of the intention to perform resuscitation according to the time elapsed since the last first-aid course.

METHODS

Between January and April 2019, the two largest companies delivering first-aid courses in the region of Geneva, Switzerland sent invitation emails on our behalf to people who had followed a first-aid course between January 2014 and December 2018. Participants were asked to answer a set of 17 psychometric questions based on a 4-point Likert scale ("I don't agree," "I partially agree," "I agree," and "I totally agree") designed to assess the three dimensions of the intention to perform resuscitation. The primary outcome was the difference in each of these dimensions between participants who had followed a first-aid course less than 6 months before taking the questionnaire and those who took the questionnaire more than 6 months and up to 5 years after following such a course. Secondary outcomes were the change in each dimension using cutoffs at 1 year and 2 years, and the change regarding each individual question using cutoffs at 6 months, 1 year, and 2 years. Univariate and multivariable linear regression were used for analyses.

RESULTS

A total of 204 surveys (76%) were analyzed. After adjustment, control beliefs was the only dimension that was significantly lower in participants who took the questionnaire more than 6 months after their last BLS course (P<.001). Resisting diffusion of responsibility, a key element of subjective normative beliefs, was also less likely in this group (P=.001). By contrast, members of this group were less afraid of disease transmission (P=.03). However, fear of legal action was higher in this group (P=.02).

CONCLUSIONS

Control beliefs already show a significant decrease 6 months after the last first-aid course. Short interventions should be designed to restore this dimension to its immediate postcourse state. This could enhance the provision of BLS maneuvers in cases of OHCA.

A Short Intervention Followed by an Interactive E-Learning Module to Motivate Medical Students to Enlist as First Responders: Protocol for a Prospective Implementation Study

BACKGROUND

In Geneva, Switzerland, basic life support (BLS) maneuvers are provided in only 40% of out-of-hospital cardiac arrests (OHCAs) cases. As OHCA outcomes are markedly improved when BLS maneuvers are swiftly applied, a "first-responder" system was introduced in 2019. When emergency dispatchers identify a possible OHCA, first responders receive an alert message on a specific app (Save-a-Life) installed on their smartphones. Those nearest to the victim and immediately available are sent the exact location of the intervention. First-year medical students only have limited knowledge regarding BLS procedures but might nevertheless need to take care of OHCA victims. Medical students responding to out-of-hospital emergencies are off-duty in half of these situations, and offering junior medical students the opportunity to enlist as first responders might therefore not only improve OHCA outcomes but also foster a greater recognition of the role medical students can hold in our society.

OBJECTIVE

Our aim is to determine whether providing first-year medical students with a short intervention followed by an interactive e-learning module can motivate them to enlist as first responders.

METHODS

After obtaining the approval of the regional ethics committee and of the vice-dean for undergraduate education of the University of Geneva Faculty of Medicine (UGFM), 2 senior medical students will present the project to their first-year colleagues at the beginning of a lecture. First-year students will then be provided with a link to an interactive e-learning module which has been designed according to the Swiss Resuscitation Council's first aid guidelines. After answering a first questionnaire and completing the module, students will be able to register for practice sessions. Those attending and successfully completing these sessions will receive a training certificate which will enable them to enlist as first responders. The primary outcome will be the proportion of first-year medical students enlisting as first responders at the end of the study period. Secondary outcomes will be the proportion of first-year medical students electing to register on the platform, to begin the e-learning module, to complete the e-learning module, to register for practice sessions, to attend the practice sessions, and to obtain a certificate. The reasons given by medical students for refusing to participate will be analyzed. We will also assess how comfortable junior medical students would feel to be integrated into the first responders system at the end of the training program and whether it affects the registration rate.

RESULTS

The regional ethics committee (Req-2020-01143) and the UGFM vice-dean for undergraduate education have given their approval to the realization of this study, which is scheduled to begin in January 2021.

CONCLUSIONS

This study should determine whether a short intervention followed by an interactive e-learning module can motivate first-year medical students to enlist as first responders.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/24664.