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Niekrenz L, Spreckelsen C. How to design effective educational videos for teaching evidence-based medicine to undergraduate learners - systematic review with complementing qualitative research to develop a practicable guide. MEDICAL EDUCATION ONLINE 2024; 29:2339569. [PMID: 38615337 PMCID: PMC11017999 DOI: 10.1080/10872981.2024.2339569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/03/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND eLearning can be an effective tool to achieve learning objectives. It facilitates asynchronous distance learning, increasing flexibility for learners and instructors. In this context, the high educational value of videos provides an invaluable primary component for longitudinal digital curricula, especially for maintaining knowledge on otherwise rarely taught subjects. Although literature concerning eLearning evaluation exists, research comprehensively describing how to design effective educational videos is lacking. In particular, studies on the requirements and design goals of educational videos need to be complemented by qualitative research using grounded theory methodology. METHODS Due to the paucity of randomized controlled trials in this area, there is an urgent need to generate recommendations based on a broader fundament than a literature search alone. Thus, the authors have employed grounded theory as a guiding framework, augmented by Mayring's qualitative content analysis and commonly used standards. An adaptive approach was conducted based on a literature search and qualitative semi-structured interviews. Drawing on these results, the authors elaborated a guide for creating effective educational videos. RESULTS The authors identified 40 effective or presumedly effective factors fostering the success of video-based eLearning in teaching evidence-based medicine, providing a ready-to-use checklist. The information collected via the interviews supported and enriched much of the advice found in the literature. DISCUSSION To the authors' knowledge, this type of comprehensive guide for video-based eLearning needs has not previously been published. The interviews considerably contributed to the results. Due to the grounded theory-based approach, in particular, consensus was achieved without the presence of a formal expert panel. Although the guide was created with a focus on teaching evidence-based medicine, due to the general study selection process and research approach, the recommendations are applicable to a wide range of subjects in medical education where the teaching aim is to impart conceptual knowledge.
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Affiliation(s)
- Lukas Niekrenz
- Institute of Medical Informatics, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Cord Spreckelsen
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
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Dutt DDCS, Carr SE, Scott TM, Petsoglou C, Grigg J, Razavi H. Educators' consideration of learner motivation in ophthalmology education in medical school: Influences on teaching practice and course design. MEDICAL TEACHER 2024; 46:387-398. [PMID: 37703439 DOI: 10.1080/0142159x.2023.2256956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Ophthalmology education in medical school has historically neglected the impact of autonomous motivation on student learning and wellbeing. This study aimed to understand ophthalmology educators' consideration and application of student motivation in ophthalmology medical education. MATERIAL AND METHODS Lead ophthalmology educators from Australian and New Zealand medical schools participated in an online semi-structured in-depth interview. Interview transcripts were analysed using thematic analysis. Codes were generated and aligned into overarching themes. FINDINGS Six educators participated in the study. Five main themes arose from the transcripts: the lack of explicit consideration of student motivation, implicit consideration of motivation in curriculum design and in teaching practices, the impact of innovation on motivation and the relationship between teacher and student motivation. Participants also commented on trends in ophthalmology education including generalists' confidence in managing ophthalmic disease, the role of fundoscopy in medical education and time pressure on ophthalmology in medical schools. CONCLUSION There has only been an implicit instead of explicit consideration of motivation in ophthalmology education in medical school, which leaves an unfulfilled potential for teaching practices to impact the affective along with cognitive and metacognitive aspects of learning. This study highlights the need for motivation to be explicitly incorporated into the development of teaching practices and curriculum reform.
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Affiliation(s)
- Deepaysh D C S Dutt
- Health Professions Education, The University of Western Australia, Perth, Western Australia, Australia
| | - Sandra E Carr
- Health Professions Education, The University of Western Australia, Perth, Western Australia, Australia
| | - Tabitha M Scott
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | | | - John Grigg
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Eye Genetics Research Group, Children's Medical Research Institute, Sydney, New South Wales, Australia
- Genetic Medicine and Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Hessom Razavi
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia
- Department of Ophthalmology, Lions Eye Institute, Perth, Western Australia, Australia
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Paul A, Leung D, Salas RME, Cruz TE, Abras C, Saylor D, Gugliucciello V, Nunn J, Gamaldo CE, Strowd RE. Comparative effectiveness study of flipped classroom versus online-only instruction of clinical reasoning for medical students. MEDICAL EDUCATION ONLINE 2023; 28:2142358. [PMID: 36333903 PMCID: PMC9645276 DOI: 10.1080/10872981.2022.2142358] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
CONTEXT Bedside clinical teaching is the backbone of clerkship education. Data-driven methods for supplementing bedside encounters with standardized content from vetted resources are needed. OBJECTIVE To compare a flipped-classroom versus an interactive online-only instruction for improving knowledge, skills, self-directed learning (SDL) behaviors, and satisfaction in a medical school clerkship. METHODS An IRB-approved prospective study employing a peer-reviewed clinical reasoning curriculum in neurology was conducted; 2nd-4th year medical students rotating through a required clerkship were enrolled. Students were randomized to flipped-classroom (i.e., flipped) or interactive asynchronous online instruction (i.e., online-only), which supplemented existing bedside teaching. Baseline and end-of-course knowledge, skill development, SDL behaviors, satisfaction, and long-term retention were assessed by peer-reviewed clinical reasoning exam, NBME scores, faculty/resident clinical evaluations, non-compulsory assignment completion, end-of-clerkship surveys, and objective structured clinical exam (OSCE). RESULTS 104 students (49 flipped, 55 online-only) were enrolled. Age, gender, and training level did not differ by group (all p > 0.43); baseline knowledge was higher in the flipped group (p = 0.003). Knowledge-based exam scores did not differ by group even after adjusting for differences in baseline knowledge (2.3-points higher in flipped group, 95%CI -0.4-4.8, p = 0.07). Clinical skills were significantly higher in the flipped group, including examination skills (4.2 ± 0.5 vs. 3.9 ± 0.7, p = 0.03) and future housestaff potential (4.8 ± 0.3 vs 4.5 ± 0.6, p = 0.03). Students in the online-only group were more likely to engage in SDL (42 vs. 12%, p = 0.001) and reported more hours studying (6.1 vs. 3.8 hours, p = 0.03). Satisfaction (p = 0.51) and OSCE scores (p = 0.28) were not different by group. CONCLUSIONS In this comparative study of two evidence-based curricular delivery approaches, we observed no difference in knowledge acquired. Greater clinical skills were observed with flipped instruction, while more SDL was observed with online-only instruction. Supplementing bedside teaching with blended instruction that balances live skill development with vetted online resources is optimal for clerkship education.
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Affiliation(s)
- Ashley Paul
- Department of Neurology, Johns Hopkins School of Medicine, 21287, Baltimore, MD, USA
| | - Doris Leung
- Department of Neurology, Johns Hopkins School of Medicine, 21287, Baltimore, MD, USA
| | - Rachel Marie E Salas
- Department of Neurology, Johns Hopkins School of Medicine, 21287, Baltimore, MD, USA
| | - Tiana E Cruz
- The Counseling Center, University of Maryland, College Park, 20742, MD, USA
| | - Chadia Abras
- Office of the Provost, Johns Hopkins University, 21218, Baltimore, MD, USA
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins School of Medicine, 21287, Baltimore, MD, USA
| | - Veronique Gugliucciello
- Center for Technology in Education, Johns Hopkins School of Education, 21218, Baltimore, MD, USA
| | - Jaqueline Nunn
- Center for Technology in Education, Johns Hopkins School of Education, 21218, Baltimore, MD, USA
| | - Charlene E Gamaldo
- Department of Neurology, Johns Hopkins School of Medicine, 21287, Baltimore, MD, USA
| | - Roy E Strowd
- Department of Neurology, Wake Forest School of Medicine, 27104, Winston Salem, NC, USA
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Omole AE, Villamil ME, Amiralli H. Medical Education During COVID-19 Pandemic: A Comparative Effectiveness Study of Face-to-Face Traditional Learning Versus Online Digital Education of Basic Sciences for Medical Students. Cureus 2023; 15:e35837. [PMID: 36891175 PMCID: PMC9988248 DOI: 10.7759/cureus.35837] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, internet-based learning modalities and online classes became a tool for the continuous learning process for medical students. The aim of this study was to compare medical student performance in both online versus offline instructional methods. METHODS The study was conducted on 213 medical students of the basic science program at the American University of Antigua, College of Medicine (AUACOM), who completed the four semesters consecutively between Spring 2018 and Fall 2020. Two cohorts of students were considered in the study: cohort 1 (those who completed years 1 and 2 using traditional offline teaching modality) and cohort 2 (those who completed year 1 offline and year 2 online). The years 1 and 2 National Board of Medical Examiners (NBME) summative assessment scores of the students were used to determine which instructional modality generated better student performance outcomes for the two groups. Additionally, we evaluated the score variabilities between genders to determine if teaching modality had an impact on a specific group. All statistical comparisons were done using two-tailed t-tests. RESULTS The study involves 213 students (112 in cohort 1, 101 in cohort 2). There was no significant difference in student performance between offline and online learners overall (74 ± 2.3 vs. 73 ± 1.3; p = 0.537) or with respect to gender (73 ± 3.8 vs. 73 ± 3.0; p = 0.709). CONCLUSION In this comparative effectiveness study of traditional offline education versus online instructional modality, we observed no statistical difference in student performance evaluated with NBME summative assessment scores. Online classes were well-accepted by our students. These data show a significant and promising potential for the future of medical education using online teaching modalities. Remote online teaching could be used again in the future without detriment to student education if face-to-face (F2F) learning is not possible.
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Affiliation(s)
- Adekunle E Omole
- Anatomical Sciences, American University of Antigua, College of Medicine, Saint John, ATG
| | - Maria Elena Villamil
- Clinical Medicine, American University of Antigua, College of Medicine, Saint John, ATG
| | - Hassan Amiralli
- Anatomical Sciences, American University of Antigua, College of Medicine, Saint John, ATG
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Andersson ML, Duch P, Bessmann EL, Lundstrøm LH, Ekelund K. Preparing for obstetric anaesthesia-An educational randomised controlled trial comparing e-learning to written course material. Acta Anaesthesiol Scand 2023; 67:36-43. [PMID: 36112027 PMCID: PMC10092133 DOI: 10.1111/aas.14148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/01/2022] [Accepted: 08/29/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND E-learning is increasingly used in postgraduate medical education. Its numerous benefits include an enhanced learning experience through learning style individualisation, interactive elements, and assessment through tests and quizzes. Current meta-analyses conclude that the overall effectiveness of e-learning is comparable to traditional teaching modalities. However, studies demonstrating its benefits are heterogeneous and of varying quality. This randomised controlled trial aims to investigate whether contemporary e-learning completed prior to a course in obstetric anaesthesia prepares the course participants better than self-study of written course material. METHODS A randomised controlled trial allocated second-year resident anaesthetists to receive either e-learning in postpartum haemorrhage and written course material in preeclampsia or e-learning in preeclampsia and written course material in postpartum haemorrhage, prior to a compulsory course in obstetric anaesthesia. The primary outcome was knowledge after completion of e-learning before the course, assessed by type X multiple-choice questions with a score ranging from zero to 35. The secondary outcomes were anxiety level before course simulations, performance during course simulations, and knowledge four and 12 weeks after the course. RESULTS The per protocol analysis of the primary outcome included 45 participants and demonstrated a mean difference of 1.8 (95% CI 0.7-2.9; p = .002) in knowledge after completion of e-learning before the course, in favour of e-learning compared to written course material. There were no statistically significant differences in the secondary outcomes. CONCLUSION This blinded parallel group randomised controlled trial found a numerically small but statistically significant difference in knowledge favouring e-learning over written course material.
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Affiliation(s)
- Mette Legaard Andersson
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense C, Denmark
| | - Patricia Duch
- Department of Anaesthesiology and Intensive Care, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Ebbe Lahn Bessmann
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark
| | - Lars Hyldborg Lundstrøm
- Department of Anaesthesiology and Intensive Care, Nordsjaellands Hospital, Hilleroed, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Kim Ekelund
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark.,Department of Anaesthesia, Juliane Marie Center, Rigshospitalet, Copenhagen, Denmark
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Undergraduate medical students’ readiness for online learning at a South African university: Implications for decentralised training. AFRICAN JOURNAL OF HEALTH PROFESSIONS EDUCATION 2022. [DOI: 10.7196/ajhpe.2022.v14i2.1433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background. Decentralised teaching has the potential to transform medical education but requires greater use of online learning to address some of the challenges of decentralised teaching in low- and middle-income countries. Given the digital divide that exists in South Africa (SA), it is necessary to establish the extent of student readiness for the broader implementation of online learning.
Objectives. To determine medical students’ device ownership, usage and attitudes towards online learning at the University of the Witwatersrand, Johannesburg.
Methods. A cross-sectional survey of first-, third- and sixth-year students was conducted in 2017. The questionnaire included open- and closed-ended questions. Quantitative data were analysed using frequency and custom tables and Kruskal-Wallis one-way analysis of variance (ANOVA) tests. Open-ended responses were analysed using content analysis.
Results. The survey response rate was 48.5% (448/924). No significant differences in device usage and attitudes towards online learning were observed across the 3 years of study. Most respondents (99%) owned internet-capable devices, and >90% wanted some degree of online learning. The perceived barriers included poor internet connectivity on university campuses and the high cost of data in SA.
Conclusion. The majority of respondents owned internet-capable devices and requested more online learning, but the socioeconomic disparities in the country raise concerns about students’ readiness. Wider online learning requires policy decisions to ensure not only access to devices and data but also the implementation of online learning in ways that avoid further disadvantaging already disadvantaged students. Institutional barriers must be addressed before an expanded online learning environment can be considered.
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Thomsen JLD, Mathiesen O, Hägi‐Pedersen D, Skovgaard LT, Østergaard D, Gätke MR, Høen‐Beck D, Balaganeshan T, Thougaard T, Guldager H, Børglum J, Olesen SDT, Janowski A. Improving neuromuscular monitoring and reducing residual neuromuscular blockade via e-learning: A multicentre interrupted time-series study (INVERT study). Acta Anaesthesiol Scand 2022; 66:580-588. [PMID: 35122234 PMCID: PMC9541262 DOI: 10.1111/aas.14038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/28/2021] [Accepted: 01/30/2022] [Indexed: 11/30/2022]
Abstract
Background Neuromuscular monitoring should be applied routinely to avoid residual neuromuscular block. However, anaesthetists often refrain from applying it, even when the equipment is available. We aimed to increase neuromuscular monitoring in six Danish anaesthesia departments via e‐learning. Methods Interrupted time series study, with baseline data from a previous study and prospective data collection after implementation of the module, which was available for 2 weeks from 21 November 2016. We included all patients receiving general anaesthesia with muscle relaxants until 30 April 2017. Main outcome was application of acceleromyography, grouped as succinylcholine only and non‐depolarising relaxants. Secondary outcomes were last recorded train‐of‐four ratio (non‐depolarising) relaxants and score on a ten‐question pre‐ and post‐course multiple‐choice test. Results The post‐intervention data consisted of 6525 cases (3099 (48%) succinylcholine only, 3426 (52%) non‐depolarising relaxants). Analysing all departments, we found a positive pre‐intervention trend in application of acceleromyography for both groups, of estimated 7.5% and 4.8% per year, respectively (p < .001). The monitoring rate increased significantly for succinylcholine in two departments post‐intervention (p = .045 and .010), and for non‐depolarising relaxants in one department (p = .041), but followed by a negative trend of −37.0% per year (p = .041). The rate was already close to 90% at the time of the intervention and the mean last recorded train‐of‐four ratio was 0.97 (SD 0.21), also without a significant change. The median score on the post‐course test increased from 7 (IQR 5–8) to 9 (IQR 8–10) (p < .001, Wilcoxon Signed‐Ranks Test). Conclusion We found no overall effect of the e‐learning module on application of neuromuscular monitoring, although the post‐course test indicated an effect on anaesthetists’ knowledge in this field. Trial registration Trial registration: Clinicaltrials.gov identifier: NCT02925143. https://clinicaltrials.gov/ct2/show/NCT02925143
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Affiliation(s)
| | - Ole Mathiesen
- Department of Anaesthesiology Zealand University Hospital Køge Denmark
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
| | - Daniel Hägi‐Pedersen
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
- Department of Anaesthesiology Slagelse and Ringsted Hospitals Næstved Denmark
| | - Lene T. Skovgaard
- Department of Biostatistics University of Copenhagen Copenhagen Denmark
| | - Doris Østergaard
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
- Copenhagen Academy for Medical Education and Simulation Herlev Hospital Herlev Denmark
| | - Mona R. Gätke
- Department of Anaesthesiology Herlev and Gentofte Hospital Herlev Denmark
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Belfi LM, Jordan SG. Web-Based Radiology Learning Module Design: The Author Perspective. Acad Radiol 2022; 29:584-590. [PMID: 33836944 DOI: 10.1016/j.acra.2021.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/07/2021] [Accepted: 02/11/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES Over recent years, e-learning has become an integral component of radiology education. While demands for innovative, interactive e-learning resources have increased, the availability of viable solutions have not kept pace. As a result, many educators are authoring their own e-learning content. This study describes the six-year experience of faculty clinician educators and residents who participated in this authoring process. MATERIALS AND METHODS From 2014 to 2020, 62 radiology faculty and residents created a total of 89 peer reviewed web-based learning modules. Authors were given instructions and materials to support their design process. Following completion of their module(s), authors were asked to complete an anonymous and voluntary survey on their perspective. RESULTS Hundred percent of survey respondents reported that they enjoyed creating their module and 97.8% would recommend the experience to others. Reported educational value of authoring a learning module was 4.18 per 5, with 65% of resident authors reporting that they felt more likely to retain the information they learned through authoring a module rather than reading a chapter on the same topic. A total of 77.3% of respondents reported that the experience would make them more likely to teach medical students in the future. CONCLUSION With the appropriate resources and support, radiology faculty and residents succeed in authorship of innovative e-learning modules for medical student learners. In addition to enhancing subject matter knowledge and satisfying Accreditation Council for Graduate Medical Education requirements for teaching and scholarly activity, authorship provides mentoring opportunities and cultivates interest in medical student education.
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Burns CL, Taubert ST, Ward EC, McCarthy KA, Graham N. Speech-language therapists' perceptions of an eLearning program to support training in videofluoroscopic swallow studies. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:257-270. [PMID: 33459451 DOI: 10.1111/1460-6984.12594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/12/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Speech-language therapists (SLTs) seek a range of educational opportunities for training in adult videofluoroscopic swallow studies (VFSS). However, variable training methods and/or unequal access to training can influence VFSS practice. AIMS To document current SLT needs and barriers to VFSS training and to determine if a new beginner-level VFSS eLearning program would assist to meet their training needs. The program incorporated multimedia modules on preparing, conducting, interpreting and reporting VFSS. METHODS & PROCEDURES SLTs with limited experience in adult VFSS completed surveys relating to VFSS training experience and barriers, and perceived changes in knowledge, skills and confidence on core VFSS module topics pre- (n = 36) and post- (n = 32) eLearning training. OUTCOMES & RESULTS Inconsistent access to VFSS training opportunities and time-related work pressures were reported as the greatest training barriers. SLTs viewed the eLearning program as a suitable option for VFSS training. Post-training, participants perceived they gained confidence, as well as improved knowledge and skills in all VFSS aspects along with generalised benefits for dysphagia management. SLTs indicated that key benefits of the eLearning program were its comprehensive content and self-directed learning with multimedia tools, which afforded theoretical and practical learning opportunities. CONCLUSIONS & IMPLICATIONS The eLearning program offered SLTs free access to beginner-level adult VFSS training, meeting many identified training needs and providing a foundation from which to develop further practical knowledge and skills within a VFSS clinic setting. What this paper adds What is already known on the subject SLTs demonstrate variable knowledge and skill in conducting and interpreting VFSS, which can impact dysphagia diagnosis and management. While access to VFSS training can be challenging, the barriers to training for SLTs have not been clearly documented. Research has confirmed that eLearning can be used effectively in healthcare education, and in some aspects of VFSS training; however, it is yet to be applied to address the broad range of VFSS training needs. What this paper adds to existing knowledge This study describes the SLT reported barriers to VFSS training which include limited access to formal and practical training, workload-related time pressures and the complexity of learning the VFSS skill set. The findings highlight that an eLearning program, was an accepted mode of learning for VFSS training. SLTs reported the online program met their learning needs by improving access to training, the multimedia program features supported their understanding of complex anatomical and physiological concepts, and training frameworks assisted their clinical reasoning and VFSS interpretation. What are the potential or actual clinical implications of this work? eLearning can assist in overcoming many VFSS training barriers identified by SLTs and the multimedia aspects of eLearning can effectively support VFSS beginner-level education to complement and expedite in-clinic practical training. Given that VFSS results inform decisions regarding commencement and progression of oral intake and swallow rehabilitation, enhanced VFSS training has the potential to positively influence dysphagia outcomes and quality of life.
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Affiliation(s)
- Clare L Burns
- Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Research in Telerehabilitation, The University of Queensland, Brisbane, QLD, Australia
| | - Shana T Taubert
- Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Elizabeth C Ward
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Research in Telerehabilitation, The University of Queensland, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Kellie A McCarthy
- Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Nicola Graham
- Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
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Verville L, Dc PC, Grondin D, Dc SM, Kay R. The development and evaluation of an online educational tool for the evidence-based management of neck pain by chiropractic teaching faculty. THE JOURNAL OF CHIROPRACTIC EDUCATION 2021; 35:95-105. [PMID: 33175979 PMCID: PMC7958658 DOI: 10.7899/jce-19-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/13/2020] [Accepted: 04/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To develop an online, interactive educational tool to deliver an evidence-based clinical practice guideline to faculty members at a Canadian chiropractic college. Second, to evaluate the learning, design, and engagement constructs of the tool in a sample of chiropractic faculty members. METHODS Using an integrated knowledge translation methodology and the Knowledge to Action Framework, we developed an evidence-based online learning tool. The context of the tool focused on a clinical practice guideline on the management of neck pain. We evaluated the learning, design, and engagement constructs in a sample of faculty members and residents using the Learning Object Evaluation Scale for Students. Participants were also asked to provide suggestions for improvement of the tool. RESULTS Sixteen participants completed the evaluation. Most (68.8%) participants were chiropractors, 75% were male and 56% were between the ages of 25 and 44 years. At least 75% of participants agreed that the learning, design, and engagement constructs of the learning tool were adequate. The open-ended suggestions unveiled 3 pedagogical themes, relating to multimedia, thinking skills, and learner control, within the tool that could benefit from further development. These themes informed recommendations to improve the tool. CONCLUSION Our online, interactive, module-based learning tool has sound pedagogical properties. Further research is needed to determine if its use is associated with a change in knowledge.
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Häusler M, Bosse HM, Fischbach T, Graf N, von Kleist-Retzow J, Kreuder J. [Alice in the digital wonderland-pediatric teaching during the COVID-19 pandemic]. Monatsschr Kinderheilkd 2020; 169:151-158. [PMID: 33281226 PMCID: PMC7709092 DOI: 10.1007/s00112-020-01076-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic led to a rapid switch from undergraduate classroom teaching to online-teaching; a challenging process for teachers and students. Based on a recent online survey among German pediatric university hospitals the "AG Lehre der DGKJ" (teaching working group of the German Society of Pediatrics and Adolescent Medicine) summarizes latest experiences with e‑learning during the summer term of 2020. The survey participants from 17 pediatric university hospitals report that the large spectrum of e‑learning formats could sufficiently replace classical lectures and seminars but could not fully replace teaching involving direct contact to patients. The introduction of new digital teaching formats is time-consuming, needs high-quality IT infrastructure, should be embedded in a continuous curriculum and provide the possibility of regular exchange between students and teachers. Teachers should be provided with the opportunity for training in didactic methods and IT skills. These results correspond to the literature on e‑learning in general and undergraduate medical education during the COVID-19 pandemic in particular. The experiences summarized here should not only facilitate the development of e‑learning tools during the ongoing pandemic but also stimulate to establish e‑learning as a valuable component of future pediatric medical education. New digital substitutes for teaching involving pediatric patients need to be developed.The statement was drafted by consensus by the German Society of Pediatrics and Adolescent Medicine Working Group on Teaching and approved by the DGKJ board.
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Affiliation(s)
- Martin Häusler
- Sektion Neuropädiatrie und Sozialpädiatrie, Klinik für Kinder- und Jugendmedizin, Uniklinikum RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Hans Martin Bosse
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf UKD, Moorenstr. 5, 40225 Düsseldorf, Deutschland
| | - Thomas Fischbach
- Berufsverband der Kinder- und Jugendärzte, BVKJ e. V. Köln, Mielenforster Str. 2, 51069 Köln, Deutschland
| | - Norbert Graf
- Klinik f. Päd. Onkologie und Hämatologie, Universitätsklinikum, Universität des Saarlandes, Campus Homburg, Gebäude 9, 66421 Homburg, Deutschland
| | | | - Joachim Kreuder
- Zentrum für Kinderheilkunde und Jugendmedizin, Universitätsklinikum Gießen und Marburg, Feulgenstr. 10–12, 35385 Gießen, Deutschland
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Merajikhah AM, Imani B, Nowruzi N. The Comparison of the Effects of Multimedia Tools and Traditional Methods on Neurosurgery Learning. EDUCATIONAL RESEARCH IN MEDICAL SCIENCES 2020; 9. [DOI: https:/doi.org/10.5812/erms.100355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 09/01/2023]
Abstract
Background: Educational multimedia software as a student-oriented educational tool provides an optimal educational condition, which allows students to view surgical videos and photographs and fill the gap between theoretical and practical training. Objectives: The present study aimed to compare the effects of multimedia tools and traditional methods on the neuroscience learning of the undergraduate students of surgical technology in Hamedan, Iran. Methods: This quasi-experimental, interventional study was conducted on 32 undergraduate students of four surgical technology courses, who were selected via convenience sampling. Neurosurgery sessions were divided into two parts, including traditional and multimedia-based education, which were used to teach the multimedia software in the field of neurosurgical topics (movies, photographs, and atlases). The learning of the students was measured by a written test. Data analysis was performed in SPSS version 23 using t-test, and paired t-test was also used to compare the differences between the traditional and multimedia education. Results: The multimedia education was more effective compared to the traditional method of learning in neurosurgery education (P < 0.001). Conclusions: According to the results, multimedia education could be used as a new and effective educational method in operating surgical technology and training.
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Sandars J, Correia R, Dankbaar M, de Jong P, Goh PS, Hege I, Masters K, Oh SY, Patel R, Premkumar K, Webb A, Pusic M. Twelve tips for rapidly migrating to online learning during the COVID-19 pandemic. MEDEDPUBLISH 2020; 9:82. [PMID: 38058947 PMCID: PMC10697562 DOI: 10.15694/mep.2020.000082.1] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
This article was migrated. The article was marked as recommended. The COVID-19 pandemic has resulted in a massive adaptation in health professions education, with a shift from in-person learning activities to a sudden heavy reliance on internet-mediated education. Some health professions schools will have already had considerable educational technology and cultural infrastructure in place, making such a shift more of a different emphasis in provision. For others, this shift will have been a considerable dislocation for both educators and learners in the provision of education. To aid educators make this shift effectively, this 12 Tips article presents a compendium of key principles and practical recommendations that apply to the modalities that make up online learning. The emphasis is on design features that can be rapidly implemented and optimised for the current pandemic. Where applicable, we have pointed out how these short-term shifts can also be beneficial for the long-term integration of educational technology into the organisations' infrastructure. The need for adaptability on the part of educators and learners is an important over-arching theme. By demonstrating these core values of the health professions school in a time of crisis, the manner in which the shift to online learning is carried out sends its own important message to novice health professionals who are in the process of developing their professional identities as learners and as clinicians.
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Pei L, Wu H. Does online learning work better than offline learning in undergraduate medical education? A systematic review and meta-analysis. MEDICAL EDUCATION ONLINE 2019; 24:1666538. [PMID: 31526248 PMCID: PMC6758693 DOI: 10.1080/10872981.2019.1666538] [Citation(s) in RCA: 294] [Impact Index Per Article: 58.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/25/2019] [Accepted: 09/05/2019] [Indexed: 05/04/2023]
Abstract
With the increasing use of technology in education, online learning has become a common teaching method. How effective online learning is for undergraduate medical education remains unknown. This article's aim is to evaluate whether online learning when compared to offline learning can improve learning outcomes of undergraduate medical students. Five databases and four key journals of medical education were searched using 10 terms and their Boolean combinations during 2000-2017. The extracted articles on undergraduates' knowledge and skill outcomes were synthesized using a random effects model for the meta-analysis.16 out of 3,700 published articles were identified. The meta-analyses affirmed a statistically significant difference between online and offline learning for knowledge and skill outcomes based on post-test scores (SMD = 0.81; 95% CI: 0.43, 1.20; p < 0.0001; n = 15). The only comparison result based on retention test scores was also statistically significant (SMD = 4.64; 95% CI: 3.19, 6.09; p < 0.00001). The meta-analyses discovered no significant difference when using pre- and post-test score gains (SMD = 3.03; 95% CI: -0.13, 4.13; p = 0.07; n = 3). There is no evidence that offline learning works better. And compared to offline learning, online learning has advantages to enhance undergraduates' knowledge and skills, therefore, can be considered as a potential method in undergraduate medical teaching.
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Affiliation(s)
- Leisi Pei
- Institute of Basic Education Science, Beijing Academy of Educational Sciences, Beijing, China
| | - Hongbin Wu
- Institute of Medical Education/National center for Health Professions Education Development, Peking University, Beijing, China
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Liaw SY, Tan KK, Wu LT, Tan SC, Choo H, Yap J, Lim SM, Wong L, Ignacio J. Finding the Right Blend of Technologically Enhanced Learning Environments: Randomized Controlled Study of the Effect of Instructional Sequences on Interprofessional Learning. J Med Internet Res 2019; 21:e12537. [PMID: 31140432 PMCID: PMC6658293 DOI: 10.2196/12537] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/26/2019] [Accepted: 03/30/2019] [Indexed: 12/14/2022] Open
Abstract
Background With the availability and capabilities of varied technologically enhanced learning activities, the blended learning approach has become increasingly popular in interprofessional education. The combined use of different technologically enhanced learning activities has not been fully examined, particularly to determine the effects of instructional sequences for effective learning outcomes. Objective The objective of this study was to investigate whether the instructional sequences of a blended learning approach can improve students’ learning outcomes on interprofessional competencies. Methods A randomized controlled study was conducted with 40 interprofessional health care teams. These teams undertook three technologically enhanced learning activities—Web-based instruction (WI), virtual reality (VR), and simulation exercise (SE)—after random assignment to three groups based on three different instructional sequences (WI-VR-SE, WI-SE-VR, and SE-WI-VR). Pretests and posttests were conducted to evaluate the students’ learning outcomes on interprofessional competencies. Results A total of 198 participants from the three groups completed the questionnaires. All three groups reported significant improvement in their levels of self-efficacy (P<.05) and attitudes (P<.001) toward interprofessional team care about 1 month after the interprofessional learning activity. Although no significant difference was found (P=.06) between the WI-VR-SE and WI-SE-VR groups in the self-efficacy posttests, participants in the SE-WI-VR group reported significantly lower (P<.05) posttest scores than those in the WI-SE-VR group. The majority of the participants (137/198, 69.1%) selected the instructional sequence “WI-VR-SE” as their top preference. Conclusions This study shows that the instructional sequence of a blended learning approach can have a significant impact on students’ learning outcomes. The learning of concepts from WI followed by problem-solving activity in the SE was found to be a more effective learning sequence than the reverse sequence. We recommend that future studies focus on scaffolding students’ learning when planning instructional sequences for technologically enhanced learning activities within blended learning environments.
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Affiliation(s)
- Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Khoon Kiat Tan
- School of Health Sciences, Nanyang Polytechnic, Singapore, Singapore
| | - Ling Ting Wu
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Seng Chee Tan
- National Institute of Education, Learning Sciences & Technologies, Nanyang Technological University, Singapore, Singapore
| | - Hyekyung Choo
- Department of Social Work, National University of Singapore, Singapore, Singapore
| | - John Yap
- National University of Singapore Information Technology, National University of Singapore, Singapore, Singapore
| | - Sok Mui Lim
- Centre for Learning Environment and Assessment Development, Singapore Institute of Technology, Singapore, Singapore
| | - Lilian Wong
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Jeanette Ignacio
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
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Chen BY, Kern DE, Kearns RM, Thomas PA, Hughes MT, Tackett S. From Modules to MOOCs: Application of the Six-Step Approach to Online Curriculum Development for Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:678-685. [PMID: 30681454 DOI: 10.1097/acm.0000000000002580] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Online curricula can make high-quality health professions education accessible in virtually any setting. They can enhance teaching and learning by both standardizing curricular resources and individualizing curricular experiences. Despite growing demand for and institutional interest in online curricula for medical education, many medical educators lack a framework for online curriculum development. Without rigorous and thoughtful development, online curricula can waste opportunity and resources by leading to education that is inferior to traditional methods. In this article, the authors describe a systematic approach to online curriculum development based on the Six-Step Approach for Curriculum Development for Medical Education, a widely used method that has led to successful implementation of a variety of traditional and online curricula. In each step, special considerations for curricula with larger and more diverse learner audiences-characteristic of many online curricula-are highlighted. Four common online curricular formats are also discussed: blended curricula, instructor-led fully online curricula, self-paced modules, and massive open online courses (MOOCs). The authors emphasize factors that differentiate one online format from another, including the budgetary, technical, and human resource requirements for each. The article concludes by urging medical educators to pursue opportunities to study and disseminate online curricular work.
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Affiliation(s)
- Belinda Y Chen
- B.Y. Chen is director, Faculty Development Programs in Curriculum Development, Johns Hopkins University School of Medicine, and assistant professor, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; ORCID: http://orcid.org/0000-0002-9905-6180. D.E. Kern is emeritus professor of medicine, past director, Faculty Development Programs in Curriculum Development, Johns Hopkins University School of Medicine, and past director, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; ORCID: http://orcid.org/0000-0002-9327-6190. R.M. Kearns is director, Online Education, Johns Hopkins University School of Medicine, Baltimore, Maryland. P.A. Thomas is professor of medicine and vice dean for medical education, Case Western Reserve University School of Medicine, Cleveland, Ohio. M.T. Hughes is assistant professor of medicine, Division of General Internal Medicine, and coeditor, Johns Hopkins Internal Medicine Ambulatory Care Curriculum on PEAC: Physician Education and Assessment Center, Johns Hopkins School of Medicine, Baltimore, Maryland. S. Tackett is assistant professor of medicine and international medical education director, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; ORCID: http://orcid.org/0000-0001-5369-7225
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Jyot A, Baloul MS, Finnesgard EJ, Allen SJ, Naik ND, Gomez Ibarra MA, Abbott EF, Gas B, Cardenas-Lara FJ, Zeb MH, Cadeliña R, Farley DR. Surgery Website as a 24/7 Adjunct to a Surgical Curriculum. JOURNAL OF SURGICAL EDUCATION 2018; 75:811-819. [PMID: 29066315 DOI: 10.1016/j.jsurg.2017.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/17/2017] [Accepted: 09/18/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Successfully teaching duty hour restricted trainees demands engaging learning opportunities. Our surgical educational website and its associated assets were assessed to understand how such a resource was being used. DESIGN Our website was accessible to all Mayo Clinic employees via the internal web network. Website access data from April 2015 through October 2016 were retrospectively collected using Piwik. SETTING Academic, tertiary care referral center with a large general surgery training program. Mayo Clinic, Rochester, MN. PARTICIPANTS A total of 257 Mayo Clinic employees used the website. RESULTS The website had 48,794 views from 6313 visits by 257 users who spent an average of 14 ± 11 minutes on the website. Our website houses 295 videos, 51 interactive modules, 14 educational documents, and 7 flashcard tutorials. The most popular content type was videos, with a total of 30,864 views. The most popular visiting time of the day was between 8 pm and 9 pm with 6358 views (13%), and Thursday was the most popular day with 17,907 views (37%). A total of 78% of users accessed content beyond the homepage. Average visits peaked in relation to 2 components of our curriculum: a 240% increase one day before our biannual intern simulation assessments, and a 61% increase one day before our weekly conducted Friday simulation sessions. Interns who rotated on the service of the staff surgeon who actively endorses the website had 93% more actions per visit as compared to other users. The highest clicks were on the home banner for our weekly simulation session pre-emptive videos, followed by "groin anatomy," and "TEP hernia repair" videos. CONCLUSIONS Our website acted as a "just-in-time" accessible portal to reliable surgical information. It supplemented the time sensitive educational needs of our learners by serving as a heavily used adjunct to 3 components of our surgical education curriculum: weekly simulation sessions, biannual assessments, and clinical rotations.
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Affiliation(s)
- Apram Jyot
- Division of Subspecialty General Surgery, Rochester, Minnesota
| | | | | | - Samuel J Allen
- Division of Subspecialty General Surgery, Rochester, Minnesota
| | - Nimesh D Naik
- Division of Subspecialty General Surgery, Rochester, Minnesota
| | | | - Eduardo F Abbott
- Multidisciplinary Simulation Center, Mayo Clinic, Rochester, Minnesota; Department of Internal Medicine, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Becca Gas
- Division of Subspecialty General Surgery, Rochester, Minnesota
| | | | - Muhammad H Zeb
- Division of Subspecialty General Surgery, Rochester, Minnesota
| | - Rachel Cadeliña
- Division of Subspecialty General Surgery, Rochester, Minnesota
| | - David R Farley
- Division of Subspecialty General Surgery, Rochester, Minnesota.
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Garside MJ, Fisher JM, Blundell AG, Gordon AL. The development and evaluation of mini-GEMs - short, focused, online e-learning videos in geriatric medicine. GERONTOLOGY & GERIATRICS EDUCATION 2018; 39:132-143. [PMID: 27050439 DOI: 10.1080/02701960.2016.1165217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Mini Geriatric E-Learning Modules (Mini-GEMs) are short, focused, e-learning videos on geriatric medicine topics, hosted on YouTube, which are targeted at junior doctors working with older people. This study aimed to explore how these resources are accessed and used. The authors analyzed the viewing data from 22 videos published over the first 18 months of the Mini-GEM project. We conducted a focus group of U.K. junior doctors considering their experiences with Mini-GEMS. The Mini-GEMs were viewed 10,291 times over 18 months, equating to 38,435 minutes of total viewing time. The average viewing time for each video was 3.85 minutes. Learners valued the brevity and focused nature of the Mini-GEMs and reported that they watched them in a variety of settings to supplement clinical experiences and consolidate learning. Watching the videos led to an increase in self-reported confidence in managing older patients. Mini-GEMs can effectively disseminate clinical teaching material to a wide audience. The videos are valued by junior doctors due to their accessibility and ease of use.
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Affiliation(s)
- Mark J Garside
- a Specialist Registrar in Geriatric and General Internal Medicine , Northumbria Healthcare NHS Foundation Trust , Northumberland , UK
| | - James M Fisher
- a Specialist Registrar in Geriatric and General Internal Medicine , Northumbria Healthcare NHS Foundation Trust , Northumberland , UK
| | - Adrian G Blundell
- b Medicine of Older People, Department of Health Care of Older People , Nottingham University Hospitals NHS Trust , Nottingham , UK
| | - Adam L Gordon
- c Medicine of Older People, Division of Medical Sciences and Graduate Entry Medicine , University of Nottingham , Nottingham , UK
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Lee LA, Wang SL, Chao YP, Tsai MS, Hsin LJ, Kang CJ, Fu CH, Chao WC, Huang CG, Li HY, Chuang CK. Mobile Technology in E-Learning for Undergraduate Medical Education on Emergent Otorhinolaryngology-Head and Neck Surgery Disorders: Pilot Randomized Controlled Trial. JMIR MEDICAL EDUCATION 2018; 4:e8. [PMID: 29519776 PMCID: PMC5865003 DOI: 10.2196/mededu.9237] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND The use of mobile technology in e-learning (M-TEL) can add new levels of experience and significantly increase the attractiveness of e-learning in medical education. Whether an innovative interactive e-learning multimedia (IM) module or a conventional PowerPoint show (PPS) module using M-TEL to teach emergent otorhinolaryngology-head and neck surgery (ORL-HNS) disorders is feasible and efficient in undergraduate medical students is unknown. OBJECTIVE The aim of this study was to compare the impact of a novel IM module with a conventional PPS module using M-TEL for emergent ORL-HNS disorders with regard to learning outcomes, satisfaction, and learning experience. METHODS This pilot study was conducted at an academic teaching hospital and included 24 undergraduate medical students who were novices in ORL-HNS. The cognitive style was determined using the Group Embedded Figures Test. The participants were randomly allocated (1:1) to one of the two groups matched by age, sex, and cognitive style: the IM group and the PPS group. During the 100-min learning period, the participants were unblinded to use the IM or PPS courseware on a 7-inch tablet. Pretests and posttests using multiple-choice questions to evaluate knowledge and multimedia situational tests to evaluate competence were administered. Participants evaluated their satisfaction and learning experience by the AttrakDiff2 questionnaire, and provided feedback about the modules. RESULTS Overall, the participants had significant gains in knowledge (median of percentage change 71, 95% CI 1-100, P<.001) and competence (median of percentage change 25, 95% CI 0-33, P=.007) after 100 min of learning. Although there was no significant difference in knowledge gain between the two groups (median of difference of percentage change 24, 95% CI -75 to 36; P=.55), competence gain was significantly lower in the IM group compared with the PPS group (median of difference of percentage change -41, 95% CI -67 to -20; P=.008). However, the IM group had significantly higher scores of satisfaction (difference 2, 95% CI 2-4; P=.01), pragmatic quality (difference 1.7, 95% CI 0.1-2.7; P=.03), and hedonic stimulation (difference 1.9, 95% CI 0.3-3.1; P=.01) compared with the PPS group. Qualitative feedback indicated that the various games in the IM module attracted the participants' attention but that the nonlinearly arranged materials affected their learning. CONCLUSIONS Using M-TEL for undergraduate medical education on emergent ORL-HNS disorders, an IM module seems to be useful for gaining knowledge, but competency may need to occur elsewhere. While the small sample size reduces the statistical power of our results, its design seems to be appropriate to determine the effects of M-TEL using a larger group. TRIAL REGISTRATION ClinicalTrials.gov NCT02971735; https://clinicaltrials.gov/ct2/show/NCT02971735 (Archived by WebCite at http://www.webcitation.org/6waoOpCEV).
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Affiliation(s)
- Li-Ang Lee
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Ling Wang
- Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Digital Learning and Education, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Yi-Ping Chao
- Graduate Institute of Medical Mechatronics, Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Shao Tsai
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Li-Jen Hsin
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Jan Kang
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia-Hsiang Fu
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Chieh Chao
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Biomedical Sciences, Department of Medical Biotechnology and Laboratory Science, Chang-Gung University, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Keng Chuang
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, Taiwan
- Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Szyld D, Uquillas K, Green BR, Yavner SD, Song H, Nick MW, Ng GM, Pusic MV, Riles TS, Kalet A. Improving the Clinical Skills Performance of Graduating Medical Students Using "WISE OnCall," a Multimedia Educational Module. Simul Healthc 2017; 12:385-392. [PMID: 29076970 PMCID: PMC5768220 DOI: 10.1097/sih.0000000000000254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION "Transitions to residency" programs are designed to maximize quality and safety of patient care, as medical students become residents. However, best instructional or readiness assessment practices are not yet established. We sought to study the impact of a screen-based interactive curriculum designed to prepare interns to address common clinical coverage issues (WISE OnCall) on the clinical skills demonstrated in simulation and hypothesize that performance would improve after completing the module. METHODS Senior medical students were recruited to participate in this single group prestudy/poststudy. Students responded to a call from a standardized nurse (SN) and assessed a standardized patient (SP) with low urine output, interacted with a 45-minute WISE OnCall module on the assessment and management of oliguria, and then evaluated a different SP with low urine output of a different underlying cause. Standardized patients assessed clinical skills with a 37-item, behaviorally anchored checklist measuring clinical skills (intraclass correlation coefficient [ICC], 0.55-0.81). Standardized nurses rated care quality and safety and collaboration and interprofessional communication using a 33-item literature-based, anchored checklist (ICC, 0.47-0.52). Standardized patient and SN ratings of the same student performance were correlated (r, 0.37-0.62; P < 0.01). Physicians assessed clinical reasoning quality based on the students' patient encounter note (ICC, 0.55-0.68), ratings that did not correlate with SP and SN ratings. We compared pre-post clinical skills performance and clinical reasoning. Fifty-two medical students (31%) completed this institutional review board -approved study. RESULTS Performance as measured by the SPs, SNs, and the postencounter note all showed improvement with mostly moderate to large effect sizes (range of Cohen's d, 0.30-1.88; P < 0.05) after completion of the online module. Unexpectedly, professionalism as rated by the SP was poorer after the module (Cohen's d, -0.93; P = 0.000). DISCUSSION A brief computer-based educational intervention significantly improved graduating medical students' clinical skills needed to be ready for residency.
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Affiliation(s)
- Demian Szyld
- From the Department of Emergency Medicine (D.S.), Brigham and Women's Hospital; The Center for Medical Simulation (D.S.), Boston, MA; New York Simulation Center for the Health Sciences (G.N., T.S.R., A.K.), New York; Institute for Innovations in Medical Education (M.V.P., T.S.R., A.K.), NYU School of Medicine, New York, NY; Department of Obstetrics and Gynecology (K.U.), University of Southern California, Los Angeles, CA; Department of Emergency Medicine (B.R.G.), The Ohio State University, Cleveland, OH; Program for Medical Education and Technology (M.W.N., T.S.R., A.K.), NYU School of Medicine, New York, NY; Department of Journalism (S.D.Y.), Central Connecticut State University; Department of Education (H.S.), Georgian Court University, Lakewood, NJ; Department of Surgery (T.S.R., A.K.), NYU School of Medicine, New York, NY; Department of Medicine (A.K.), Division of General Internal Medicine, Research on Medical Education Outcomes (ROMEO) Unit, and Program for Medical Education Innovation and Research (PrMEIR) (A.K.), NYU School of Medicine, New York, NY
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Thomsen JLD, Mathiesen O, Hägi-Pedersen D, Skovgaard LT, Østergaard D, Engbaek J, Gätke MR. Improving Neuromuscular Monitoring and Reducing Residual Neuromuscular Blockade With E-Learning: Protocol for the Multicenter Interrupted Time Series INVERT Study. JMIR Res Protoc 2017; 6:e192. [PMID: 28986337 PMCID: PMC5650673 DOI: 10.2196/resprot.7527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 12/18/2022] Open
Abstract
Background Muscle relaxants facilitate endotracheal intubation under general anesthesia and improve surgical conditions. Residual neuromuscular blockade occurs when the patient is still partially paralyzed when awakened after surgery. The condition is associated with subjective discomfort and an increased risk of respiratory complications. Use of an objective neuromuscular monitoring device may prevent residual block. Despite this, many anesthetists refrain from using the device. Efforts to increase the use of objective monitoring are time consuming and require the presence of expert personnel. A neuromuscular monitoring e-learning module might support consistent use of neuromuscular monitoring devices. Objective The aim of the study is to assess the effect of a neuromuscular monitoring e-learning module on anesthesia staff’s use of objective neuromuscular monitoring and the incidence of residual neuromuscular blockade in surgical patients at 6 Danish teaching hospitals. Methods In this interrupted time series study, we are collecting data repeatedly, in consecutive 3-week periods, before and after the intervention, and we will analyze the effect using segmented regression analysis. Anesthesia departments in the Zealand Region of Denmark are included, and data from all patients receiving a muscle relaxant are collected from the anesthesia information management system MetaVision. We will assess the effect of the module on all levels of potential effect: staff’s knowledge and skills, patient care practice, and patient outcomes. The primary outcome is use of neuromuscular monitoring in patients according to the type of muscle relaxant received. Secondary outcomes include last recorded train-of-four value, administration of reversal agents, and time to discharge from the postanesthesia care unit as well as a multiple-choice test to assess knowledge. The e-learning module was developed based on a needs assessment process, including focus group interviews, surveys, and expert opinions. Results The e-learning module was implemented in 6 anesthesia departments on 21 November 2016. Currently, we are collecting postintervention data. The final dataset will include data from more than 10,000 anesthesia procedures. We expect to publish the results in late 2017 or early 2018. Conclusions With a dataset consisting of thousands of general anesthesia procedures, the INVERT study will assess whether an e-learning module can increase anesthetists’ use of neuromuscular monitoring. Trial Registration Clinicaltrials.gov NCT02925143; https://clinicaltrials.gov/ct2/show/NCT02925143 (Archived by WebCite® at http://www.webcitation.org/6s50iTV2x)
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Affiliation(s)
| | - Ole Mathiesen
- Department of Anesthesiology, Zealand University Hospital, Koege, Denmark
| | | | | | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jens Engbaek
- Department of Anesthesiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mona Ring Gätke
- Department of Anesthesiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
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Kalet A, Zabar S, Szyld D, Yavner SD, Song H, Nick MW, Ng G, Pusic MV, Denicola C, Blum C, Eliasz KL, Nicholson J, Riles TS. A simulated "Night-onCall" to assess and address the readiness-for-internship of transitioning medical students. Adv Simul (Lond) 2017; 2:13. [PMID: 29450014 PMCID: PMC5806245 DOI: 10.1186/s41077-017-0046-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/24/2017] [Indexed: 11/10/2022] Open
Abstract
Transitioning medical students are anxious about their readiness-for-internship, as are their residency program directors and teaching hospital leadership responsible for care quality and patient safety. A readiness-for-internship assessment program could contribute to ensuring optimal quality and safety and be a key element in implementing competency-based, time-variable medical education. In this paper, we describe the development of the Night-onCall program (NOC), a 4-h readiness-for-internship multi-instructional method simulation event. NOC was designed and implemented over the course of 3 years to provide an authentic "night on call" experience for near graduating students and build measurements of students' readiness for this transition framed by the Association of American Medical College's Core Entrustable Professional Activities for Entering Residency. The NOC is a product of a program of research focused on questions related to enabling individualized pathways through medical training. The lessons learned and modifications made to create a feasible, acceptable, flexible, and educationally rich NOC are shared to inform the discussion about transition to residency curriculum and best practices regarding educational handoffs from undergraduate to graduate education.
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Affiliation(s)
- Adina Kalet
- New York Simulation Center for the Health Sciences, New York, New York USA
- Institute for Innovations in Medical Education, NYU School of Medicine, New York, USA
- Program for Medical Education and Technology (PMET), NYU School of Medicine, New York, USA
- Department of Surgery, NYU School of Medicine, New York, USA
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, OBV CD-401, 462 1st Avenue, New York, New York 10016 USA
| | - Sondra Zabar
- Institute for Innovations in Medical Education, NYU School of Medicine, New York, USA
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, OBV CD-401, 462 1st Avenue, New York, New York 10016 USA
| | - Demian Szyld
- Department of Emergency Medicine, Center for Medical Simulation, Institute for Medical Simulation, Harvard Medical School, Boston, MA USA
| | - Steven D Yavner
- Department of Journalism, Central Connecticut State University, New Britain, CT USA
| | - Hyuksoon Song
- Department of Education, Georgian Court University, Lakewood, NJ USA
| | - Michael W Nick
- Program for Medical Education and Technology (PMET), NYU School of Medicine, New York, USA
| | - Grace Ng
- New York Simulation Center for the Health Sciences, New York, New York USA
| | - Martin V Pusic
- Department of Emergency Medicine, NYU School of Medicine, New York, New York USA
- Institute for Innovations in Medical Education, NYU School of Medicine, New York, USA
| | - Christine Denicola
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, OBV CD-401, 462 1st Avenue, New York, New York 10016 USA
| | - Cary Blum
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York, New York USA
| | - Kinga L Eliasz
- Program for Medical Education and Technology (PMET), NYU School of Medicine, New York, USA
| | - Joey Nicholson
- Health Science Library, NYU School of Medicine, New York, New York USA
| | - Thomas S Riles
- New York Simulation Center for the Health Sciences, New York, New York USA
- Institute for Innovations in Medical Education, NYU School of Medicine, New York, USA
- Program for Medical Education and Technology (PMET), NYU School of Medicine, New York, USA
- Department of Surgery, NYU School of Medicine, New York, USA
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Ortega-Morán JF, Pagador JB, Sánchez-Peralta LF, Sánchez-González P, Noguera J, Burgos D, Gómez EJ, Sánchez-Margallo FM. Validation of the three web quality dimensions of a minimally invasive surgery e-learning platform. Int J Med Inform 2017; 107:1-10. [PMID: 29029684 DOI: 10.1016/j.ijmedinf.2017.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/31/2017] [Accepted: 07/09/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION E-learning web environments, including the new TELMA platform, are increasingly being used to provide cognitive training in minimally invasive surgery (MIS) to surgeons. A complete validation of this MIS e-learning platform has been performed to determine whether it complies with the three web quality dimensions: usability, content and functionality. METHODS 21 Surgeons participated in the validation trials. They performed a set of tasks in the TELMA platform, where an e-MIS validity approach was followed. Subjective (questionnaires and checklists) and objective (web analytics) metrics were analysed to achieve the complete validation of usability, content and functionality. RESULTS The TELMA platform allowed access to didactic content with easy and intuitive navigation. Surgeons performed all tasks with a close-to-ideal number of clicks and amount of time. They considered the design of the website to be consistent (95.24%), organised (90.48%) and attractive (85.71%). Moreover, they gave the content a high score (4.06 out of 5) and considered it adequate for teaching purposes. The surgeons scored the professional language and content (4.35), logo (4.24) and recommendations (4.20) the highest. Regarding functionality, the TELMA platform received an acceptance of 95.24% for navigation and 90.48% for interactivity. CONCLUSIONS According to the study, it seems that TELMA had an attractive design, innovative content and interactive navigation, which are three key features of an e-learning platform. TELMA successfully met the three criteria necessary for consideration as a website of quality by achieving more than 70% of agreements regarding all usability, content and functionality items validated; this constitutes a preliminary requirement for an effective e-learning platform. However, the content completeness, authoring tool and registration process required improvement. Finally, the e-MIS validity methodology used to measure the three dimensions of web quality in this work can be applied to other clinical areas or training fields.
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Affiliation(s)
| | - J Blas Pagador
- Jesús Usón Minimally Invasive Surgery Centre, Bioengineering and Health Technologies, Cáceres, Spain
| | | | - Patricia Sánchez-González
- Universidad Politécnica de Madrid, Biomedical Technology Centre, ETSI Telecomunicación, Madrid, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - José Noguera
- Hospital Son Llàtzer, Palma de Mallorca, Spain(1)
| | | | - Enrique J Gómez
- Universidad Politécnica de Madrid, Biomedical Technology Centre, ETSI Telecomunicación, Madrid, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
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Abstract
Key publications on training in dentistry, including the latest version of the General Dental Council learning outcomes for dentists, recognise the importance of teaching evidence-based practice for dental students. However, dental curriculum designers have considerable flexibility on the scope and approach for teaching evidence-based dentistry (EBD) and there is no readily available information showing how EBD is taught across the dental schools in the United Kingdom (UK). Critical appraisal is one of the key steps of evidence-based decision making and so we investigated through an electronic survey whether and how critical appraisal skills (CAS) are taught and assessed across the UK dental schools. The survey included questions regarding teaching methods, duration and timing of CAS teaching, and assessment methods. Twelve out of the total 16 UK dental schools participated in this survey, giving an institutional response rate of 75%. While all 12 participating UK dental schools reported CAS were taught and assessed in their institution, there were very varied approaches between institutions in every surveyed aspect of CAS education. CAS teaching and assessment strategies should be regularly reviewed in line with the evolving dental curriculum. Regular inter- and intra-institutional review of teaching, specifically in evidence-based dentistry including CAS may encourage professional debate regarding facilitation of improved CAS and their integration into clinical practice.
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Berman NB, Durning SJ, Fischer MR, Huwendiek S, Triola MM. The Role for Virtual Patients in the Future of Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:1217-22. [PMID: 26959224 DOI: 10.1097/acm.0000000000001146] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The medical education community is working-across disciplines and across the continuum-to address the current challenges facing the medical education system and to implement strategies to improve educational outcomes. Educational technology offers the promise of addressing these important challenges in ways not previously possible. The authors propose a role for virtual patients (VPs), which they define as multimedia, screen-based interactive patient scenarios. They believe VPs offer capabilities and benefits particularly well suited to addressing the challenges facing medical education. Well-designed, interactive VP-based learning activities can promote the deep learning that is needed to handle the rapid growth in medical knowledge. Clinically oriented learning from VPs can capture intrinsic motivation and promote mastery learning. VPs can also enhance trainees' application of foundational knowledge to promote the development of clinical reasoning, the foundation of medical practice. Although not the entire solution, VPs can support competency-based education. The data created by the use of VPs can serve as the basis for multi-institutional research that will enable the medical education community both to better understand the effectiveness of educational interventions and to measure progress toward an improved system of medical education.
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Affiliation(s)
- Norman B Berman
- N.B. Berman is professor, Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. S.J. Durning is professor of medicine and pathology, Uniformed Services University, Bethesda, Maryland. M.R. Fischer is professor and chair for medical education, Institut für Didaktik und Ausbildungsforschung in der Medizin, University Hospital, LMU Munich, Germany. S. Huwendiek is senior lecturer and head of the department, Department of Assessment and Evaluation, Institute of Medical Education, University of Bern, Bern, Switzerland. M.M. Triola is associate professor and associate dean for educational informatics, New York University School of Medicine, New York, New York
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De Leeuw RA, Westerman M, Nelson E, Ket JCF, Scheele F. Quality specifications in postgraduate medical e-learning: an integrative literature review leading to a postgraduate medical e-learning model. BMC MEDICAL EDUCATION 2016; 16:168. [PMID: 27390843 PMCID: PMC4939034 DOI: 10.1186/s12909-016-0700-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 06/11/2016] [Indexed: 05/10/2023]
Abstract
BACKGROUND E-learning is driving major shifts in medical education. Prioritizing learning theories and quality models improves the success of e-learning programs. Although many e-learning quality standards are available, few are focused on postgraduate medical education. METHODS We conducted an integrative review of the current postgraduate medical e-learning literature to identify quality specifications. The literature was thematically organized into a working model. RESULTS Unique quality specifications (n = 72) were consolidated and re-organized into a six-domain model that we called the Postgraduate Medical E-learning Model (Postgraduate ME Model). This model was partially based on the ISO-19796 standard, and drew on cognitive load multimedia principles. The domains of the model are preparation, software design and system specifications, communication, content, assessment, and maintenance. CONCLUSION This review clarified the current state of postgraduate medical e-learning standards and specifications. It also synthesized these specifications into a single working model. To validate our findings, the next-steps include testing the Postgraduate ME Model in controlled e-learning settings.
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Affiliation(s)
- R. A. De Leeuw
- />Athena Institute for Trans-disciplinary Research, VU University Amsterdam, De Boelelaan 1118, Amsterdam, 1081 HZ The Netherlands
| | - M. Westerman
- />VUmc, School of Medical Sciences, Amsterdam, The Netherlands
| | - E. Nelson
- />Division of Pediatric Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, USA
| | - J. C. F. Ket
- />VU University Amsterdam, University Library, Amsterdam, The Netherlands
| | - F. Scheele
- />Athena Institute for Trans-disciplinary Research, VU University Amsterdam, De Boelelaan 1118, Amsterdam, 1081 HZ The Netherlands
- />VUmc, School of Medical Sciences, Amsterdam, The Netherlands
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