Evaluating technology-enhanced learning: A comprehensive framework

A randomized controlled educational pilot trial of interictal epileptiform discharge identification for neurology residents

OBJECTIVE

To assess the effectiveness of an educational program leveraging technology-enhanced learning and retrieval practice to teach trainees how to correctly identify interictal epileptiform discharges (IEDs).

METHODS

This was a bi-institutional prospective randomized controlled educational trial involving junior neurology residents. The intervention consisted of three video tutorials focused on the six IFCN criteria for IED identification and rating 500 candidate IEDs with instant feedback either on a web browser (intervention 1) or an iOS app (intervention 2). The control group underwent no educational intervention ("inactive control"). All residents completed a survey and a test at the onset and offset of the study. Performance metrics were calculated for each participant.

RESULTS

Twenty-one residents completed the study: control (n = 8); intervention 1 (n = 6); intervention 2 (n = 7). All but two had no prior EEG experience. Intervention 1 residents improved from baseline (mean) in multiple metrics including AUC (.74; .85; p < .05), sensitivity (.53; .75; p < .05), and level of confidence (LOC) in identifying IEDs/committing patients to therapy (1.33; 2.33; p < .05). Intervention 2 residents improved in multiple metrics including AUC (.81; .86; p < .05) and LOC in identifying IEDs (2.00; 3.14; p < .05) and spike-wave discharges (2.00; 3.14; p < .05). Controls had no significant improvements in any measure.

SIGNIFICANCE

This program led to significant subjective and objective improvements in IED identification. Rating candidate IEDs with instant feedback on a web browser (intervention 1) generated greater objective improvement in comparison to rating candidate IEDs on an iOS app (intervention 2). This program can complement trainee education concerning IED identification.

In-Person Versus Online Training in Simulations of Helping Babies Breathe: A Randomized Controlled Trial

BACKGROUND

Birth asphyxia is a leading cause of neonatal deaths, but simple interventions may prevent it. The Helping Babies Breathe (HBB) course has significantly reduced neonatal mortality rates in lower and middle-income countries (LMICs) by training healthcare providers (i.e. midwives and nurses) on the essential skills of bag-and-mask ventilation and postnatal care. Although several studies have supported the efficacy of virtual learning in other medical education programs, there is still a lack of knowledge regarding a virtual approach to HBB. This study aims to compare the effectiveness of online versus in-person learning of the HBB course among medical and nursing students.

METHODS

The study is a two-arm parallel randomized non-inferiority controlled trial, that includes medical and nursing students. Participants were randomly assigned to either online or in-person debriefing during the hands-on simulations of HBB. They attended a pre-recorded lecture before being assigned to one of three instructors for the simulation lab. Participants completed a seven-point anonymous Likert-based questionnaire and a standardized Debriefing Assessment for Simulation in Healthcare Student Version (DASH-SV) Short Form. The primary outcome was the Objective Structured Clinical Exam (OSCE) grade. The trial is listed on ClinicalTrials.gov with the registration number NCT05257499.

RESULTS

47 participants completed the study, with similar baseline characteristics in each arm (gender, age, and class). The participants in both arms reported high levels of satisfaction and confidence, with no significant difference between the two arms. The DASH score over 7 was also similar in the online arm (6.27±0.26) compared to the in-person arm (6.55±0.13) (p=0.07). The mean OSCE score in the online arm (45.8±5.2) was comparable to the mean OSCE score in the in-person arm (41.3±5.0) (p=0.22). Both online and in-person participants failed the OSCE.

CONCLUSION

The survey responses conveyed that online simulation training is comparable to in-person simulation for the HBB course. Both online and in-person participants failed the OSCE most likely because they needed more training on HBB. This could be due to the fact that the material is too new to the students who needed more practice to pass the OSCE. Further research is needed to confirm these results and explore the long-term impact of online neonatal resuscitation training.

The feasibility and usability of mixed reality teaching in a hospital setting based on self-reported perceptions of medical students

BACKGROUND

Clinical teaching during encounters with real patients lies at the heart of medical education. Mixed reality (MR) using a Microsoft HoloLens 2 (HL2) offers the potential to address several challenges: including enabling remote learning; decreasing infection control risks; facilitating greater access to medical specialties; and enhancing learning by vertical integration of basic principles to clinical application. We aimed to assess the feasibility and usability of MR using the HL2 for teaching in a busy, tertiary referral university hospital.

METHODS

This prospective observational study examined the use of the HL2 to facilitate a live two-way broadcast of a clinician-patient encounter, to remotely situated third and fourth year medical students. System Usability Scale (SUS) Scores were elicited from participating medical students, clinician, and technician. Feedback was also elicited from participating patients. A modified Evaluation of Technology-Enhanced Learning Materials: Learner Perceptions Questionnaire (mETELM) was completed by medical students and patients.

RESULTS

This was a mixed methods prospective, observational study, undertaken in the Day of Surgery Assessment Unit. Forty-seven medical students participated. The mean SUS score for medical students was 71.4 (SD 15.4), clinician (SUS = 75) and technician (SUS = 70) indicating good usability. The mETELM Questionnaire using a 7-point Likert Scale demonstrated MR was perceived to be more beneficial than a PowerPoint presentation (Median = 7, Range 6-7). Opinion amongst the student cohort was divided as to whether the MR tutorial was as beneficial for learning as a live patient encounter would have been (Median = 5, Range 3-6). Students were positive about the prospect of incorporating of MR in future tutorials (Median = 7, Range 5-7). The patients' mETELM results indicate the HL2 did not affect communication with the clinician (Median = 7, Range 7-7). The MR tutorial was preferred to a format based on small group teaching at the bedside (Median = 6, Range 4-7).

CONCLUSIONS

Our study findings indicate that MR teaching using the HL2 demonstrates good usability characteristics for providing education to medical students at least in a clinical setting and under conditions similar to those of our study. Also, it is feasible to deliver to remotely located students, although certain practical constraints apply including Wi-Fi and audio quality.

Curating a media-linked curriculum

BACKGROUND

The COVID-19 pandemic motivated considerable educational innovation in technology-enhanced learning (TEL), and educators must now thoughtfully apply identified best practices to both in-person and virtual learning experiences through instructional design and reflective practice. This paper describes the development and evaluation of an innovation utilising TEL to enhance our core curriculum content and students' learning.

APPROACH

The curriculum-linked media (CLM) was introduced as a part of a doctoring and clinical skills course for pre-clinical medical students as a structured curriculum that pairs audio and/or video-based content with reflection prompts designed to prime students for active, in-person learning upon arrival to their classrooms. The CLM aimed to help students (1) gain a deeper understanding of the course content, (2) partake in reflective practice and (3) explore diverse perspectives on a particular topic.

EVALUATION

All students completed a survey at the end of their academic year to evaluate the activity. Some students found the innovation helpful in that it facilitated perspective taking and prepared them for their in-person class. The reflection questions that paired with the media prompted discussion in class and a deeper connection with the materials. Making the content relevant to the local community and highlighting regional issues made the activity more relatable.

IMPLICATIONS

Our experience demonstrated that the CLM model can be a helpful and efficient tool to stretch the educational reach of the classroom. Future applications may consider the implementation and evaluation of the model with clinical students and postgraduate trainees.

Delivering clinical tutorials to medical students using the Microsoft HoloLens 2: A mixed-methods evaluation

BACKGROUND

Mixed reality offers potential educational advantages in the delivery of clinical teaching. Holographic artefacts can be rendered within a shared learning environment using devices such as the Microsoft HoloLens 2. In addition to facilitating remote access to clinical events, mixed reality may provide a means of sharing mental models, including the vertical and horizontal integration of curricular elements at the bedside. This study aimed to evaluate the feasibility of delivering clinical tutorials using the Microsoft HoloLens 2 and the learning efficacy achieved.

METHODS

Following receipt of institutional ethical approval, tutorials on preoperative anaesthetic history taking and upper airway examination were facilitated by a tutor who wore the HoloLens device. The tutor interacted face to face with a patient and two-way audio-visual interaction was facilitated using the HoloLens 2 and Microsoft Teams with groups of students who were located in a separate tutorial room. Holographic functions were employed by the tutor. The tutor completed the System Usability Scale, the tutor, technical facilitator, patients, and students provided quantitative and qualitative feedback, and three students participated in semi-structured feedback interviews. Students completed pre- and post-tutorial, and end-of-year examinations on the tutorial topics.

RESULTS

Twelve patients and 78 students participated across 12 separate tutorials. Five students did not complete the examinations and were excluded from efficacy calculations. Student feedback contained 90 positive comments, including the technology's ability to broadcast the tutor's point-of-vision, and 62 negative comments, where students noted issues with the audio-visual quality, and concerns that the tutorial was not as beneficial as traditional in-person clinical tutorials. The technology and tutorial structure were viewed favourably by the tutor, facilitator and patients. Significant improvement was observed between students' pre- and post-tutorial MCQ scores (mean 59.2% Vs 84.7%, p < 0.001).

CONCLUSIONS

This study demonstrates the feasibility of using the HoloLens 2 to facilitate remote bedside tutorials which incorporate holographic learning artefacts. Students' examination performance supports substantial learning of the tutorial topics. The tutorial structure was agreeable to students, patients and tutor. Our results support the feasibility of offering effective clinical teaching and learning opportunities using the HoloLens 2. However, the technical limitations and costs of the device are significant, and further research is required to assess the effectiveness of this tutorial format against in-person tutorials before wider roll out of this technology can be recommended as a result of this study.

The co-development and evaluation of an e-learning course on spinal cord injury physical activity counselling: a randomized controlled trial

BACKGROUND

Health, fitness and lifestyle professionals can play important roles in promoting physical activity in groups at risk of developing an inactive lifestyle, such as people with spinal cord injury (SCI). Tailored counselling is a promising tool to promote and improve physical activity levels. To support professionals to effectively have a conversation about physical activity with clients with SCI, evidence-based training and resources are needed. This project aimed to (1) co-develop an e-learning course on best practices for SCI physical activity counselling and, (2) examine the effectiveness and usability of this course.

METHODS

Guided by the technology-enhanced learning (TEL) evaluation framework, we used a systematic, multistep approach to co-develop and evaluate an e-learning course. The development process was informed by input and feedback from a diverse group of end-users and experts (n > 160) via online surveys and (think-aloud) interviews. A randomized controlled trial was used to compare learning outcomes (post-knowledge and self-efficacy) between participants who completed the course (intervention group) and the wait-listed control group. Usability, learning experiences, and satisfaction were assessed among all participants.

RESULTS

Forty-one participants (21 intervention-group; 20 control-group) with various backgrounds (e.g., lifestyle counsellors, physiotherapists, occupational therapists, recreation therapists, fitness trainers) enrolled in the randomized controlled trial. After completing the course, participants in the intervention group showed significantly improved knowledge on the best practices for SCI physical activity counselling and higher self-efficacy for using these best practices in conversations with clients with SCI compared to the control group (p <.001). Participants reported above average usability scores, positive learning experiences, and high levels of satisfaction when completing the course.

CONCLUSION

We used a systematic, multi-step, theory-informed approach to co-develop and evaluate an evidence-based e-learning course on SCI physical activity counselling to support professionals to promote physical activity in their daily practices. The overall positive findings demonstrate that the e-learning course is feasible and ready for further implementation in various health and community settings. Implementation of the e-learning course can help professionals improve the physical activity support they provide to their clients, and subsequently increase physical activity participation in people with SCI.

Designing and Developing Online Training for Diabetes Prevention Program Coaches Using an Integrated Knowledge Translation Approach: Development and Usability Study

BACKGROUND

e-Learning has rapidly become a popular alternative to in-person learning due to its flexibility, convenience, and wide reach. Using a systematic and partnered process to transfer in-person training to an e-learning platform helps to ensure the training will be effective and acceptable to learners.

OBJECTIVE

This study aimed to develop an e-learning platform for Small Steps for Big Changes (SSBC) type 2 diabetes prevention program coaches to improve the viability of coach training.

METHODS

An integrated knowledge translation approach was used in the first 3 stages of the technology-enhanced learning (TEL) evaluation framework to address the study objective. This included three steps: (1) conducting a needs analysis based on focus groups with previously trained SSBC coaches, meetings with the SSBC research team, and a review of research results on the effectiveness of the previous in-person version of the training; (2) documenting processes and decisions in the design and development of the e-learning training platform; and (3) performing usability testing. Previously trained SSBC coaches and the SSBC research team were included in all stages of this study.

RESULTS

Step 1 identified components from the in-person training that should be maintained in the e-learning training (ie, a focus on motivational interviewing), additional components to be added to the e-learning training (ie, how to deliver culturally safe and inclusive care), and mode of delivery (videos and opportunities to synchronously practice skills). Step 2 documented the processes and decisions made in the design and development of the e-learning training, including the resources (ie, time and finances) used, the content of the training modules, and how coaches would flow through the training process. The design and development process consisted of creating a blueprint of the training. The training included 7 e-learning modules, the learning modalities of which included narrated demonstration videos and user-engaging activities, a mock session with feedback from the research team, and a final knowledge test. Step 3, usability testing, demonstrated high levels of learnability, efficiency, memorability, and satisfaction, with minor bugs documented and resolved.

CONCLUSIONS

Using an integrated knowledge translation approach to the technology-enhanced learning evaluation framework was successful in developing an e-learning training platform for SSBC coaches. Incorporating end users in this process can increase the chances that the e-learning training platform is usable, engaging, and acceptable. Future research will include examining the satisfaction of coaches using the SSBC coach e-learning training platform, assessing coach learning outcomes (ie, knowledge and behavior), and estimating the cost and viability of implementing this training.

Simulation in a blended learning curriculum for neonatology

Blended learning is a learner-centered educational method that combines online and traditional face-to-face educational strategies. Simulation is a commonly utilized platform for experiential learning and an ideal component of a blended learning curriculum. This section describes blended learning, including its strengths and limitations, educational frameworks, uses within health professions education, best practices, and challenges. Also included is a brief introduction to simulation-based education, along with theoretical and real-world examples of how simulation may be integrated into a blended learning curriculum. Examples of blended learning in Neonatal-Perinatal Medicine, specifically within the Neonatal Resuscitation Program, procedural skills training, and the National Neonatology Curriculum, are reviewed.

An Opportunity to See the Heart Defect Physically: Medical Student Experiences of Technology-Enhanced Learning with 3D Printed Models of Congenital Heart Disease

Three-dimensional (3D) printing is increasingly used in medical education and paediatric cardiology. A technology-enhanced learning (TEL) module was designed to accompany 3D printed models of congenital heart disease (CHD) to aid in the teaching of medical students. There are few studies evaluating the attitudes and perceptions of medical students regarding their experience of learning about CHD using 3D printing. This study aimed to explore senior medical students' experiences in learning about paediatric cardiology through a workshop involving 3D printed models of CHD supported by TEL in the form of online case-based learning. A mixed-methods evaluation was undertaken involving a post-workshop questionnaire (n = 94 students), and focus groups (n = 16 students). Focus group and free-text questionnaire responses underwent thematic analysis. Questionnaire responses demonstrated widespread user satisfaction; 91 (97%) students agreed that the workshop was a valuable experience. The highest-level satisfaction was for the physical 3D printed models, the clinical case-based learning, and opportunity for peer collaboration. Thematic analysis identified five key themes: a variable experience of prior learning, interplay between physical and online models, flexible and novel workshop structure, workshop supported the learning outcomes, and future opportunities for learning using 3D printing. A key novel finding was that students indicated the module increased their confidence to teach others about CHD and recommended expansion to other parts of the curriculum. 3D printed models of CHD are a valuable learning resource and contribute to the richness and enjoyment of medical student learning, with widespread satisfaction.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01840-w.

Using XR (Extended Reality) for Behavioral, Clinical, and Learning Sciences Requires Updates in Infrastructure and Funding

Extended reality (XR, including augmented and virtual reality) creates a powerful intersection between information technology and cognitive, clinical, and education sciences. XR technology has long captured the public imagination, and its development is the focus of major technology companies. This article demonstrates the potential of XR to (1) deliver behavioral insights, (2) transform clinical treatments, and (3) improve learning and education. However, without appropriate policy, funding, and infrastructural investment, many research institutions will struggle to keep pace with the advances and opportunities of XR. To realize the full potential of XR for basic and translational research, funding should incentivize (1) appropriate training, (2) open software solutions, and (3) collaborations between complementary academic and industry partners. Bolstering the XR research infrastructure with the right investments and incentives is vital for delivering on the potential for transformative discoveries, innovations, and applications.

Developing a European longitudinal and interprofessional curriculum for clinical reasoning

Clinical reasoning is a complex and crucial ability health professions students need to acquire during their education. Despite its importance, explicit clinical reasoning teaching is not yet implemented in most health professions educational programs. Therefore, we carried out an international and interprofessional project to plan and develop a clinical reasoning curriculum with a train-the-trainer course to support educators in teaching this curriculum to students. We developed a framework and curricular blueprint. Then we created 25 student and 7 train-the-trainer learning units and we piloted 11 of these learning units at our institutions. Learners and faculty reported high satisfaction and they also provided helpful suggestions for improvements. One of the main challenges we faced was the heterogeneous understanding of clinical reasoning within and across professions. However, we learned from each other while discussing these different views and perspectives on clinical reasoning and were able to come to a shared understanding as the basis for developing the curriculum. Our curriculum fills an important gap in the availability of explicit clinical reasoning educational materials both for students and faculty and is unique with having specialists from different countries, schools, and professions. Faculty time and time for teaching clinical reasoning in existing curricula remain important barriers for implementation of clinical reasoning teaching.

Examining the Effectiveness of an E-Learning Training Course for Coaches of a Type 2 Diabetes Prevention Program

Small Steps for Big Changes (SSBC) is a community-based diabetes prevention program (DPP). SSBC utilizes a motivational interviewing (MI) informed counseling style to deliver a structured diet and exercise curriculum to empower healthy behavioral modifications and prevent type 2 diabetes (T2D). An electronic learning (e-learning) platform to train SSBC coaches was developed to improve flexibility, reach, and accessibility. While e-learning has shown to be an effective mode of teaching content to health professionals, less is known in the context of DPP coaches. This study aimed to assess the effectiveness of the SSBC e-learning course. Twenty coaches (eleven fitness staff personnel and nine university students) were recruited through existing fitness facilities to participate in the online SSBC coach training which included completing pre- and post-training questionnaires, seven online modules of content and a mock client session. Knowledge regarding MI (Mpre = 3.30 ± 1.95, Mpost = 5.90 ± 1.29; p < 0.01), SSBC content (Mpre = 5.15 ± 2.23, Mpost = 8.60 ± 0.94; p < 0.01), and T2D (Mpre = 6.95 ± 1.57, Mpost = 8.25 ± 0.72; p < 0.01), and self-efficacy to deliver the program (Mpre = 7.93 ± 1.51, Mpost = 9.01 ± 1.00; p < 0.01) all significantly increased from pre- to post e-learning training. Participants reported positively on the user satisfaction and feedback questionnaire with a mean score of 4.58/5 (SD = 0.36). These findings suggest e-learning platforms are a promising mode to improve DPP coaches' knowledge, counseling skills, and to bolster confidence in program delivery with high levels of satisfaction. E-learning to train DPP coaches allows for effective and feasible expansion of DPP's, ultimately permitting more reach to adults living with prediabetes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41347-023-00316-3.

Screening methods for congenital anomalies in low and lower-middle income countries: A systematic review

INTRODUCTION

Surgically correctable congenital anomalies are responsible for a significant burden of morbidity and mortality in children from low-and lower-middle-income countries (LMICs). Early identification through fetal and neonatal screening is critical to reducing death and disability. This study aims to identify feasible screening methods for surgically correctable congenital anomalies in LMICs.

METHODS

A systematic search looking at screening for congenital anomalies in LMIC was conducted in seven databases from 2000 until May 25, 2020, with no language restriction. All articles discussing screening methods for surgically correctable congenital anomalies in LMICs were included. Articles were screened by two independent contributors using Rayyan software, with a third contributor resolving conflicts. Feasibility of the screening method and its risk of bias were assessed using the MINORS scale.

RESULTS

Of 3473 articles, 24 were included in the full-text review. Nine screening methods (three prenatal and six postnatal) were identified - the most frequently utilized being physician clinical examination (45.8%), pulse oximetry (33.3%) and fetal ultrasound (20.8%). The use of a birth defect picture toolkit was the most feasible screening method. The risk of bias scale yielded an average of 11.9 points, which corresponds to a moderate level of bias.

CONCLUSION

Despite clear benefits, prenatal and neonatal screening methods are infrequently used in LMICs to identify surgically correctable congenital anomalies in neonates, likely due to financial, material, and human resource constraints. Further research into the development of low-cost feasible methods is needed within these settings.

PROSPERO REGISTRATION NUMBER

CRD42020192051.

TYPE OF STUDY

Systematic review.

LEVEL OF EVIDENCE

IV.

Evolution in Congenital Cardiology Education: The Rise of Digital-Learning Tools

Technology-enhanced learning is now an established part of medical education due to its ready availability and on-demand nature. This offers new opportunities but also challenges to both learners and teachers. This review outlines the current use of social media tools and online resources in medical education with a particular emphasis on congenital cardiology. It provides strategies to the reader on how to optimize learning in the digital environment and offers guidance on how such tools can be incorporated into routine educational practice. Suggestions for developing and assessing educational material online are discussed. Lastly, the concepts of digital professionalism and digital scholarship are explored to aid medical teachers and educators employ these technologies effectively into their teaching and career development.

Technology-enhanced trauma training in low-resource settings: A scoping review and feasibility analysis of educational technologies

BACKGROUND

Lack of training contributes to the burden of trauma-related mortality and morbidity in low- and lower-middle-income countries (LMICs). Educational technologies present a unique opportunity to enhance the quality of trauma training. Therefore, this study reviews current technologies used in trauma courses and evaluates their feasibility for LMICs.

METHODS

We conducted a scoping review evaluating the learning outcomes of technology-enhanced training in general trauma assessment, team skills or any procedures covered in the 2020 Advanced Trauma Life Support® program. Based on the Technology-Enhanced Learning criteria, we created and applied a feasibility analysis tool to evaluate the technologies for use in LMICs.

RESULTS

We screened 6471 articles and included 64. Thirty-four (45%) articles explored training in general trauma assessment, 28 (37%) in team skills, and 24 (32%) in procedures. The most common technologies were high-fidelity mannequins (60%), video-assisted debriefing (19%), and low-fidelity mannequins (13%). Despite their effectiveness, high-fidelity mannequins ranked poorly in production, maintenance, cost, and reusability categories, therefore being poorly suited for LMICs. Virtual simulation and digital courses had the best feasibility scores, but still represented a minority of articles in our review.

CONCLUSION

To our knowledge, this is the first study to perform a feasibility analysis of trauma training technologies in the LMIC context. We identified that the majority of trauma courses in the literature use technologies which are less suitable for LMICs. Given the urgent need for pediatric trauma training, educators must use technologies that optimize learning outcomes and remain feasible for low-resource settings.

LEVEL OF EVIDENCE

IV.

Preparing for obstetric anaesthesia-An educational randomised controlled trial comparing e-learning to written course material

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.

Evaluating a Photogrammetry-Based Video for Undergraduate Anatomy Education

Modern anatomy education has benefitted from the development of a wide range of digital 3D resources in the past decades, but the impact of the COVID-19 pandemic has sparked an additional demand for high-quality online learning resources. Photogrammetry provides a low-cost technique for departments to create their own photo-realistic 3D models of cadaveric specimens. However, to ensure accessibility, the design of the resulting learning resources should be carefully considered. We aimed to address this by creating a video based on a photogrammetry model of a cadaveric human lung. Students evaluated three different versions of this video in a Likert-type online survey. Most responding students found this type of video useful for their learning and helpful for the identification of anatomical structures in real cadaveric specimens. Respondents also showed a preference for specific design features such as a short video length, white text on black background, and the presence of captions. The positive student feedback is promising for the future development of photogrammetry-based videos for anatomy education and this study has provided pilot data to improve the accessibility of such videos.

Virtual Supervision of Third Year Medical Students Using Handheld POCUS Devices and Cloud-based Image Archiving Provides Opportunity for Feedback and Skill Improvement

Background : Feedback on Point of Care Ultrasound (POCUS) skills is essential for skill development. Providing feedback can be difficult in a large province with several distributed medical education sites. Use of handheld POCUS devices and a cloud-based image archiving enables virtual supervision. We evaluated the quality of uploaded images as well as feedback provided to students. Methods: Volunteer third year students were given access to handheld POCUS devices at various training sites. Students were encouraged to upload educational POCUS scans to their accounts where they would then receive feedback from faculty. Subsequently, images that met inclusion criteria were randomized and reviewed by a blinded expert using a global rating scale. Feedback was also analyzed. Finally, students completed a questionnaire on their technology-enhanced POCUS learning experience. Results: An independent-sampled t-test comparing mean ratings for initial images submitted prior to any feedback with those submitted after three rounds of feedback showed significant effect on image scores (2.60 vs 3.50, p = .040, d = .93). Feedback included 4 performance domains (indications, image generation, interpretation, and integration). Students found the technology easy to use and felt feedback was tailored to their learning needs. Conclusions: We observed that virtual feedback provided to medical students through a cloud-based work platform can be effective for enhancing POCUS skills.

Just-in-Time Teaching (JiTT) Screencasts: a Randomized Controlled Trial of Asynchronous Learning on an Inpatient Hematology-Oncology Teaching Service

BACKGROUND

The efficacy of just-in-time teaching (JiTT) screencasts for graduate medical education on an inpatient adult hematology-oncology service (HOS) setting is not known. Our preceding pilot data identified six high-yield topics for this setting. The study objective was to evaluate screencast educational efficacy.

METHODS

Internal medicine residents scheduled to start a rotation on the primary HOS of an academic medical center were eligible for this parallel, unblinded, randomized controlled trial with concealed allocation. Participants underwent block randomization to the usual educational curriculum either with or without access to a series of novel screencasts; all participants received an anonymous online end-of-rotation survey and a $20 gift certificate upon completion. The primary outcome was the change in attitude among learners, measured as their self-reported confidence for managing the clinical topics.

RESULTS

From 12/9/2019 through 6/15/2020, accrual was completed with 67 of 78 eligible residents (86%) enrolled and randomized. Analysis was by intention-to-treat and participant response rate was 91%. Sixty-four percent of residents in the treatment arm rated their clinical management comfort level as "comfortable" or "very comfortable" versus 21% of residents in the usual education arm (p = 0.001), estimated difference = 43% (95% CI: 21-66%), using a prespecified cumulative cutoff score. Treatment arm participants reported that the screencasts improved medical oncology knowledge base (100%), would improve their care for cancer patients (92%), and had an enjoyable format (96%).

CONCLUSION

Residents on a busy inpatient HOS found that a JiTT screencast increased clinical comfort level in the management of HOS-specific patient problems.

Technology-enhanced learning interventions on skin of colour dermatology for dermatology trainees and fellows: are they effective or sustainable?

Recent shifts towards synchronous online learning and raised awareness of ethnic inequalities in health have resulted in the establishment of frequent 'one-off' technology-enhanced learning (TEL) initiatives on diversity issues. There is little established evidence regarding the efficacy or sustainability of such interventions. We designed a prospective cohort pilot study including 14 dermatology registrars and fellows and delivered a TEL programme focusing on central centrifugal cicatricial alopecia and keloid scarring. Information was collected on the existing competence and confidence of our cohort about managing these conditions, as well as the short-term and long-term impact of our intervention. Following our programme, participant knowledge improved transiently, but was not sustainable 6 weeks later. Over half of participants were not confident in adopting newly acquired knowledge on skin of colour into practice. Results demonstrate a disparity between how effective one-off education initiatives are perceived vs. actual benefit. More systemic solutions may be warranted.

Can web-based implementation interventions improve physician early diagnosis of cerebral palsy? Protocol for a 3-arm parallel superiority randomised controlled trial and cost-consequence analysis comparing adaptive and non-adaptive virtual patient instructional designs with control to evaluate effectiveness on physician behaviour, diagnostic skills and patient outcomes

INTRODUCTION

Cerebral palsy (CP) is the most common childhood physical disability. Accurate diagnosis before 6 months is possible using predictive tools and decision-making skills. Yet diagnosis is typically made at 12-24 months of age, hindering access to early interventions that improve functional outcomes. Change in practice is required for physicians in key diagnostic behaviours. This study aims to close the identified research-practice gap and increase accurate CP diagnosis before 6 months of age through tailored web-based implementation interventions. This trial will determine whether adaptive e-learning using virtual patients, targeting CP diagnostic behaviours and clinical decision-making skills, effectively changes physician behaviour and practice compared with non-adaptive e-learning instructional design or control.

METHODS AND ANALYSIS

This study is a 3-arm parallel superiority randomised controlled trial of two tailored e-learning interventions developed to expedite physician CP diagnosis. The trial will compare adaptive (arm 1) and non-adaptive (arm 2) instructional designs with waitlist control (arm 3) to evaluate change in physician behaviour, skills and diagnostic practice. A sample size of 275 paediatric physicians enables detection of small magnitude effects (0.2) of primary outcomes between intervention comparators with 90% power (α=0.05), allowing for 30% attrition. Barrier analysis, Delphi survey, Behaviour Change Wheel and learning theory frameworks guided the intervention designs. Adaptive and non-adaptive video and navigation sequences utilising virtual patients and clinical practice guideline content were developed, integrating formative key features assessment targeting clinical decision-making skills relative to CP diagnosis.Physician outcomes will be evaluated based on postintervention key feature examination scores plus preintervention/postintervention behavioural intentions and practice measures. Associations with CP population registers will evaluate real-world diagnostic patient outcomes. Intervention costs will be reported in a cost-consequence analysis from funders' and societal perspectives.

ETHICS AND DISSEMINATION

Ethics approved from The University of Sydney (Project number 2021/386). Results will be disseminated through peer-reviewed journals and scientific conferences.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry: ACTRN 12622000184774.

Using 3D Printing to Improve Student Education of Complex Anatomy: a Systematic Review and Meta-analysis

Objective

Additive manufacturing has played an increasingly important role in the field of health care. One of the most recent applications has been the development of 3D printed anatomical models specifically to improve student education. The purpose of this review was to assess the potential for 3D printed models to improve understanding of complex anatomy in undergraduate and medical/professional students.

Methods

A systematic review was performed to investigate the different implementations of 3D printed anatomical models in educational curricula. In addition, a meta-analysis was conducted to assess the differences in comprehension between students who received 3D printed models as part of their instruction and those taught with traditional methods.

Results

Of the 10 groups included in the meta-analysis, students whose educational experience included a 3D printed model scored roughly 11% better on objective assessments compared to students who did not use such models (Hedge's g = 0.742, p < 0.001).

Conclusion

Based on these findings, the use of 3D printed anatomical models as a method of education is likely to improve students' understanding of complex anatomical structures.

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.

E-learning/online education in transfusion medicine: A cross-sectional international survey

OBJECTIVES

This survey aims to assess the scope of transfusion e-learning courses in blood establishments and transfusion services internationally.

BACKGROUND

E-learning/online education is increasingly used in the education of medical professionals. There is limited published data on the use of e-learning for transfusion medicine.

MATERIAL AND METHODS

An International survey was designed and distributed to all members of the International Society of Blood Transfusion to assess utilisation of e-learning in their institutions. Descriptive statistics were used to summarise the results.

RESULTS

A total of 177 respondents participated, 68 of which had e-learning modules in their institutions. Approximately two-thirds of the courses were developed in-house (66%), and 63% are available to learners from outside the host institutions. In one-third of institutions, these courses were established during the COVID-19 pandemic, while 15% had used e-learning courses for more than 10 years. The courses target different audiences and topics ranging from blood donation to hemovigilance. The most common audiences were physicians (71%), laboratory scientists/technologists (69%) and transfusion practitioners (63%). Formal assessment of learning outcomes is used in 70% of the programs.

CONCLUSIONS

The survey demonstrates the widespread use of e-learning courses in transfusion education, with a substantial proportion being developed during the COVID-19 pandemic.

Technology enhanced assessment: Ottawa consensus statement and recommendations

INTRODUCTION

In 2011, a consensus report was produced on technology-enhanced assessment (TEA), its good practices, and future perspectives. Since then, technological advances have enabled innovative practices and tools that have revolutionised how learners are assessed. In this updated consensus, we bring together the potential of technology and the ultimate goals of assessment on learner attainment, faculty development, and improved healthcare practices.

METHODS

As a material for the report, we used the scholarly publications on TEA in both HPE and general higher education, feedback from 2020 Ottawa Conference workshops, and scholarly publications on assessment technology practices during the Covid-19 pandemic.

RESULTS AND CONCLUSION

The group identified areas of consensus that remained to be resolved and issues that arose in the evolution of TEA. We adopted a three-stage approach (readiness to adopt technology, application of assessment technology, and evaluation/dissemination). The application stage adopted an assessment 'lifecycle' approach and targeted five key foci: (1) Advancing authenticity of assessment, (2) Engaging learners with assessment, (3) Enhancing design and scheduling, (4) Optimising assessment delivery and recording learner achievement, and (5) Tracking learner progress and faculty activity and thereby supporting longitudinal learning and continuous assessment.

Blended and e-learning in pediatric education: harnessing lessons learned from the COVID-19 pandemic

Face-to-face education as the traditional basis for medical education was disrupted by the COVID-19 pandemic as learners and educators were moved online with little time for preparation. Fortunately, as online learning has grown, together with medical education shifting to problem-based and team-centered learning over the last three decades, existing resources have been adapted and improved upon to meet the challenges. Effective blended learning has resulted in innovative synchronous and asynchronous learning platforms. Clearly, to do this well requires time, effort, and adjustment from clinicians, educators, and learners, but it should result in an engaging change in teaching practice. Its success will rely on an evaluation of learning outcomes, educator and learner satisfaction, and long-term retention of knowledge. It will be important to maintain ongoing assessment of all aspects of the medical education process, including how to best teach and assess theory, physiology, pathology, history-taking, physical examination, and clinical management.Conclusion: The COVID-19 pandemic triggered emergency transitional processes for teaching and assessment in medical education which built upon existing innovations in teaching medicine with the use of technology. These strategies will continue to evolve so as to provide the basis for an enduring hybrid teaching model involving blended and e-learning in medical education.. What is Known: • Most pediatricians provide clinical teaching to medical students and residents, but few have had formal training in online educational approaches and techniques. • Being able to adapt to new and innovative integrated teaching methods is of key importance when becoming a competent teacher. What is New: • This review presents an up-to-date summary of best practice in blended and e-learning and how it may be optimally delivered. • Knowledge of the principles of e-learning, and how people learn more generally, helps pediatricians shape their clinical teaching and facilitates better interaction with medical students and residents.

National Implementation and Evaluation of a Virtual Subinternship in Urology

OBJECTIVES

To conduct a nationwide evaluation of student and program director (PD) perspectives of virtual subinternships that took place during the COVID-19 pandemic.

METHODS

In December 2020, we distributed anonymous surveys to all 534 urology residency applicants and 161 urology PDs at academic medical centers across the United States to evaluate virtual subinternships. Surveys assessed curriculum composition, goals, satisfaction, barriers, and future reusability. The primary outcome was overall satisfaction with the subinternship, evaluated on a 5-point Likert scale.

RESULTS

The survey was completed by 174 students (33%) and 82 PDs (51%), including 81 students (47%) and 32 PDs (41%) who participated in virtual subinternships at 29 institutions. Overall, 77% of students and 78% of PDs rated the electives "excellent" or "very good." On ordinal logistic regression, higher student ratings were associated with duration ≥3 weeks (OR 4.64, p=0.003) and class size ≤4 students (OR 3.33, p=0.015). Higher PD ratings were associated with full-time electives (OR 11.18, p=0.019), class size ≤4 students (OR 13.99, p=0.042), and utilization of the standardized Guidebook from the Society of Academic Urologists (OR 11.89, p=0.038). The most commonly reported challenge to the subinternship's efficacy was lack of hands-on learning (87% of students and 81% of PDs). Looking forward, 45% of students and 66% of PDs recommended incorporating virtual components into future electives.

CONCLUSIONS

The virtual subinternship was a coordinated nationwide initiative to provide urologic education to medical students during a pandemic. The most successful courses were structured with longer duration, full-time commitment, and small class size.

An eLearning program to prepare residents for a rotation in pediatric emergency medicine: A qualitative study

Background:

To meet ACGME-I (Accreditation Council for Graduate Medical Education–International) training and duty hour requirements, we converted our 3-week-long pediatric emergency medicine induction program to an eLearning program.

Objectives:

The study aimed to identify areas of the eLearning program residents perceived useful and the components that helped them prepare for clinical work.

Methods:

The qualitative study took place in a tertiary pediatric emergency department. Twenty-seven residents from family medicine, emergency medicine, and pediatric medicine participated in focus group discussions to explore how they perceived the eLearning program helped prepare them for work. The interviews were audio-recorded, and transcripts were analyzed and coded into categories and themes.

Results:

Four themes emerged from the data analysis: residents’ access to the eLearning program, instructional methods, eLearning design elements, and supplementary learning. Residents valued autonomy to control their pace of learning and use online features that matched their preferred learning styles. Design features such as the use of questions and quizzes helped stimulate learning, but attention had to be paid to the order of questions in the modules and the format of the questions. Written guidelines served as a good reference for learners and face-to-face sessions accompanying the eLearning program helped reinforce knowledge and offered opportunities to interact with faculty members to clarify questions.

Conclusion:

Systematic planning focusing on access, instructional methods, and design is essential when creating eLearning programs for residency training. eLearning programs can be enhanced by the incorporation of team-based learning and having accompanying written content to reference.

Morning report for all: a qualitative study of disseminating case conferences via podcasting

BACKGROUND

Despite its long-established importance, diagnostic reasoning (DR) education has suffered uneven implementation in medical education. The Clinical Problem Solvers (CPSolvers) podcast has emerged as a novel strategy to help teach DR through case conferences with expert diagnosticians and trainees. CPSolvers has 25,000 listeners in 147 countries. The aim of this study was to evaluate the podcast by eliciting the developers' goals of the podcast, then determining to what extent they aligned with the listeners' actual usage habits, features they valued, and perceptions of the podcast.

METHODS

We conducted semi-structured interviews with 3 developers and 8 listeners from April-May 2020, followed by qualitative thematic analysis.

RESULTS

Three major developer goals with sub-goals resulted: 1. To teach diagnostic reasoning in a case-based format by (1a) teaching schemas, (1b) modeling expert diagnostic reasoning, (1c) teaching clinical knowledge, and (1d) teaching diagnostic reasoning terminology. 2. To change the culture of medicine by (2a) promoting diversity, (2b) modeling humility and promoting psychological safety, and (2c) creating a fun, casual way to learn. 3. To democratize the teaching of diagnostic reasoning by leveraging technology. Listeners' usage habits, valued features, and perceptions overall strongly aligned with all these aspects, except for (1c) clinical knowledge, and (1d) diagnostic reasoning terminology. Listeners identified (1a) schemas, and (2c) promotion of psychological safety as the most valuable features of the podcast.

CONCLUSION

CPSolvers has been perceived as a highly effective and novel way to disseminate DR education in the form of case conferences, serving as an alternative to traditional in-person case conferences suspended during COVID-19. CPSolvers combines many known benefits of in-person case conferences with a compassionate and entertaining teaching style, plus advantages of the podcasting medium - democratizing morning report for listeners around the world.

E-learning in clinical microbiology and infectious diseases

BACKGROUND

Becoming and staying competent is a challenge in clinical microbiology and infectious diseases because of dramatic increases in medical knowledge, discovery of new pathogens, emerging infections, new resistance mechanisms and laboratory techniques. E-learning is an effective way of meeting educational needs by providing more efficient and flexible training. E-learning resources have become more important to acquire new knowledge and skills, especially at a time of physical distancing.

OBJECTIVES

This review aims to summarize the implementation of e-learning in clinical microbiology and infectious diseases with references to existing examples and resources.

SOURCES

Literature and online resources for e-learning, online teaching/education in medical education, clinical microbiology and infectious diseases.

CONTENT

The principles and common methods of e-learning and frequently used digital tools are described. For all aspects of e-learning/distance learning, available resources and examples of applications in clinical microbiology and infectious diseases are presented.

IMPLICATIONS

The techniques, tools and resources described in this article should be considered for the development and implementation of e-learning programmes in clinical microbiology and infectious disease training.

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.

Comparison of flipped learning and traditional lecture method for teaching digestive system diseases in undergraduate medicine: A prospective non-randomized controlled trial

INTRODUCTION

This study examined the effects of a large-scale flipped learning (FL) approach in an undergraduate course of Digestive System Diseases.

METHODS

This prospective non-randomized trial recruited 404 students over three academic years. In 2016, the course was taught entirely in a Traditional Lecture (TL) style, in 2017 half of the course (Medical topics) was replaced by FL while the remaining half (Surgical topics) was taught by TL and in 2018, the whole course was taught entirely by FL. Academic performance, class attendance and student's satisfaction surveys were compared between cohorts.

RESULTS

Test scores were higher in the FL module (Medical) than in the TL module (Surgical) in the 2017 cohort but were not different when both components were taught entirely by TL (2016) or by FL (2018). Also, FL increased the probability of reaching superior grades (scores >7.0) and improved class attendance and students' satisfaction.

CONCLUSION

The holistic FL model is more effective for teaching undergraduate clinical gastroenterology compared to traditional teaching methods and has a positive impact on classroom attendances.

Slack as a virtual undergraduate dermatology community: a pilot study

Background

Dermatology is under‐represented in UK undergraduate curricula, and with a diagnostic and educational toolkit that is heavily centred on face‐to‐face (F2F) clinical examination, dermatology education has been disproportionately affected by the COVID‐19 pandemic. Online channel‐based messaging apps such as Slack offer an opportunity to engage students in remote, multimodal collaborative learning by reproducing a classroom environment in the virtual space.

Aim

To determine the feasibility, acceptability and proof of concept for an online Slack community in undergraduate dermatology education.

Methods

Undergraduate medical students participated in an online classroom for a 6‐week programme encompassing case‐based discussions, seminars and journal clubs. The platform was facilitated by junior doctors (n = 10) and patient educators (n = 6). Students and faculty completed a post‐course evaluation. Students additionally completed a pre‐ and post‐intervention dermatology quiz. Mixed methods analyses included quantitative analyses to explore data trends and qualitative phenomenographic analyses to assimilate key underlying themes.

Results

Students (n = 65) were enrolled to join the platform. The evaluation was completed by students (n = 52) from UK universities (n = 27). The majority of students (n = 27) interacted with the platform as passive observers (≤ 5 active interactions with the channel), with a small group (n = 4) of ‘super‐users’ (≥ 100 active interactions). The overall quality of the course was described as ‘excellent’ by 96% of participants and 100% of faculty.

Conclusion

A community‐based online classroom can act as an enjoyable, acceptable and collaborative means of delivering dermatology education to undergraduate medical students. Its ease of use and supportive nature may also facilitate patient involvement. Such advances may provide vital safeguards against the reduction in F2F learning that has accompanied the COVID‐19 pandemic.

Immersive Video Modeling Versus Traditional Video Modeling for Teaching Central Venous Catheter Insertion to Medical Residents

Background 

Central Venous Catheter (CVC) placement is a common critical care procedure. Simulated practice has been shown to reduce its iatrogenic complications. Video modeling (VM) is an instructional adjunct that improves the quality and success of CVC insertion. Immersive VM can improve recall and skill translation, but its role in teaching medical procedures is not established.

Research question/hypothesis

We hypothesized that, relative to traditional VM, immersive VM would decrease cognitive load and enhance ultrasound-guided CVC insertion skill acquisition.

Methods

Thirty-two resident physicians from four specialties were randomized into traditional (control) or immersive VM (intervention) groups for three CVC training sessions. Cognitive load was quantified via NASA Task Load Index (TLX). Mean (± standard deviations) values were compared using two-tailed t-tests. Skill acquisition was quantified by procedural time and the average 5-point [EM1] [TB2] entrustment score of three expert raters.

Results

Overall entrustment scores improved from the first (3.44±0.98) to the third (4.06±1.23; p<0.002) session but were not significantly different between the control and intervention groups. There were no significant differences between NASA TLX scores or procedural time.

Conclusion

We found no significant difference in entrustment, cognitive load, or procedural time. Immersive VM was not found to be superior to traditional VM for teaching CVC insertion.

Augmented reality in medical education: a systematic review

INTRODUCTION

The field of augmented reality (AR) is rapidly growing with many new potential applications in medical education. This systematic review investigated the current state of augmented reality applications (ARAs) and developed an analytical model to guide future research in assessing ARAs as teaching tools in medical education.

METHODS

A literature search was conducted using PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar. This review followed PRISMA guidelines and included publications from January 1, 2000 to June 18, 2018. Inclusion criteria were experimental studies evaluating ARAs implemented in healthcare education published in English. Our review evaluated study quality and determined whether studies assessed ARA validity using criteria established by the GRADE Working Group and Gallagher et al., respectively. These findings were used to formulate an analytical model to assess the readiness of ARAs for implementation in medical education.

RESULTS

We identified 100,807 articles in the initial literature search; 36 met inclusion criteria for final review and were categorized into three categories: Surgery (23), Anatomy (9), and Other (4). The overall quality of the studies was poor and no ARA was tested for all five stages of validity. Our analytical model evaluates the importance of research quality, application content, outcomes, and feasibility of an ARA to gauge its readiness for implementation.

CONCLUSION

While AR technology is growing at a rapid rate, the current quality and breadth of AR research in medical training is insufficient to recommend the adoption into educational curricula. We hope our analytical model will help standardize AR assessment methods and define the role of AR technology in medical education.

Teaching orthodontic emergencies using the "flipped classroom" method of teaching-A mixed methods RCT

INTRODUCTION

In the United Kingdom, the General Dental Council requires newly graduated dentists to be competent in managing orthodontic emergencies. Undergraduate students typically receive limited exposure to orthodontics, with teaching primarily delivered via conventional lectures. Flipped teaching involves knowledge being acquired in students' own time, with class time focussing on construction of meaning.

METHODS

A total of 61 undergraduate dental students were randomised into either a flipped or a conventional group. The conventional group (n = 30) attended a lecture describing the management of six common emergencies. The flipped group (n = 31) were given access to six videos via a virtual learning environment and later completed practical tasks related to the material. Both groups completed a single best answer assessment. Perceptions of flipped classroom teaching were explored via focus groups.

RESULTS

For questions on orthodontic emergencies, the conventional group had a mean examination result of 70.5% (SD 8.0%) compared with the flipped group of 72.8% (SD 12.9%). There was no significant difference between the groups (P = .532). For regular orthodontic questions, the conventional group had a mean examination result of 64.8% (SD: 19.9%) compared with 78.3% (SD: 21.7%). There was no significant difference between the groups (P = .083). Thematic analysis identified the following themes: ways in which videos encourages more effective learning, improved engagement, awareness of learning needs and proposed teaching/curriculum changes. The overarching theoretical perspective was facilitating an experiential learning cycle using flipped classroom teaching.

CONCLUSIONS

In the context of this investigation, the flipped classroom method of teaching resulted in comparable examination performance and improved levels of satisfaction.

A web-based clinical pedagogy program to enhance registered nurse preceptors' teaching competencies - An innovative process of development and pilot program evaluation

BACKGROUND

Registered Nurse Preceptors guide students to integrate theory into practice, assess clinical competencies, and enhance problem-solving skills. Researches have indicated that the teaching competencies of nurse preceptors can be transferred to students' clinical learning.

OBJECTIVES

The aims of the study are to develop a web-based clinical pedagogy (WCP) program for Registered Nurse Preceptors and conduct pilot program evaluation.

DESIGN

A three-step process was applied to integrate the theoretical framework, evidence from the systematic review, and content validity by the experts and pilot test with the Registered Nurse Preceptors in the content and technical development of the program. The WCP program has unique features including use of dashboard, interactive videos, consultation with experts, discussion forum and backend data analysis.

RESULTS

A committee of six content experts evaluated the comprehensiveness, appropriateness, and relevancy of the program. The item-Content Validity Index (CVI) score ranged from 0.83 to 1.00 and the scale-CVI score was 0.87, which indicated that the WCP program had a strong content validity. Ten nurse preceptors were invited to use the WCP program. Preceptors shared that the website was easy to use and navigate. They commented that the videos in each module are beneficial for nurses to understand the real situation in the clinical setting. This feature also makes the website more interactive. Feedback from preceptors was subsequently used to further refine the program.

DISCUSSION AND CONCLUSION

The WCP program is an evidence-based program that provides a comprehensive coverage on clinical teaching pedagogy and assessment strategies. The unique web-based technology and interactive features provide a platform for nurse preceptors to discuss clinical encounters with peers and consult experts. The flexible and resource-rich nature of web-based learning encourages nurses to use it for continuing education.

Is online case-based learning effective in helping undergraduate medical students choose the appropriate antibiotics to treat important infections?

Background

Medical students are frequently confused about indication for and choice of antibiotic. We developed an online learning resource that focused on antibiotic stewardship and important infections where medical students could practise their antibiotic decision-making skills safely.

Methods

The resource was made available to third-year undergraduate medical students via their virtual learning environment. It covered the theory and fundamentals of antibiotic stewardship and five clinical cases covering important infections. We assessed the number of attempts taken to achieve the required level of understanding to pass each activity and surveyed a selection of students for their feedback.

Results

Of 310 students, over 80% engaged with the theory-based components, with an average score exceeding 90% (range 93.4%–99.7%). Eighty-three percent (258/310) engaged with the first two cases (Clostridioides difficile infection and pyelonephritis) but only 61% (189/310) of students completed the fifth case on bacterial meningitis. Only 49.4% (153/310) of students completed all five cases, with 48% (73/153) of these achieving ≥90% on their first attempt of the associated quizzes. Fifty-nine percent (23/39) agreed or strongly agreed that the quality of the learning resource was excellent. Seventy-two percent (28/39) agreed or strongly agreed that the objectives of the resource were relevant to their needs as undergraduate medical students. Only 33% (13/39) reported the resource would change their practice.

Conclusions

Student feedback was positive but engagement with the cases needs improvement. Highlighting the utility of case-based technology-enhanced learning as a safe place to practise antibiotic decision-making skills among students may improve this.

Evaluation of the impact of a nationwide massive online open course on the appropriate use of antimicrobials

Objectives

To evaluate the impact of a massive online open course (MOOC) design on the appropriate use of antimicrobial agents, to determine specific study areas with better learning outcomes and to identify weak points.

Methods

A pre- and post-intervention study in the context of a training course on infectious diseases aimed at health professionals. We designed a questionnaire with 30 questions related to the management of infectious diseases in different clinical situations. Participants had to answer the questions based on their competencies and training for these situations. We analysed the scores obtained before and after the course and the resulting progress. In addition, an open response section was provided to enable a qualitative evaluation.

Results

Two thousand one hundred and forty-eight health professionals were enrolled in the course. The questionnaire was completed before and after the course by 606 participants, mainly physicians (81.2%) and pharmacists (15.4%). The mean overall scores for the pre- and post-course questionnaires were 6.2 (SD 1.38) and 7.9 (SD 0.88), respectively (overall score increase = 1.8, SD 1.21, P < 0.001). A significant increase in self-assessment was detected (P < 0.001) for all the questions. Qualitative assessments were provided by 218 participants with 225 comments, most of which were very positive.

Conclusions

The course with a MOOC design showed a great teaching capacity in the infectious diseases area for all the clinical situations analysed, notably in the management of severe infections with higher mortality. For future editions of this training activity, the need to include other infectious diseases, especially infections in primary care, was highlighted.

Peer-supported faculty development and workplace teaching: an integrative review

CONTEXT

The use of peer support as a faculty development technique to improve clinical teaching is uncommon in medical education, despite the benefits of situating learning in the workplace. The authors therefore conducted a broad search seeking theoretical and empirical literature describing peer support strategies for clinical teachers in health care workplaces. This included descriptive and non-experimental studies that are often excluded from reviews. The review aimed to identify and assess existing initiatives and to synthesise key challenges and benefits.

METHODS

An integrative literature review was undertaken (2004-2017), based on searches of eight international electronic databases and targeted manual searches. Key concepts, elements and models were mapped using an iterative, constant comparative method. An evaluative framework, drawing on previous research, informed conclusions regarding the quality of evidence.

RESULTS

From a pool of 5735 papers, 34 met the inclusion criteria. The majority referred to studies conducted in the USA (59%) and in the medical profession (71%). Analysis revealed a trend towards using a collaborative model (56%), voluntary participation (59%), and direct workplace observation by a peer clinician (68%). Design features of the peer support strategy were commonly reported (65%), with half providing outcome measures (56%). Few papers reported on process evaluation (15%) or evidence of programme sustainability (15%). Despite logistical and time-associated challenges, benefits accrued to individuals and the workplace, and included improved teaching practices. Embedding the peer support strategy into routine organisational practice proved effective.

CONCLUSIONS

The results indicated that a workplace-based peer support model is an acceptable and effective faculty development strategy for health care clinical teachers. Conceptualising workplace-based peer support via a sociocultural model that acknowledges the significance of educational design, peers as collaborators and the importance of workplace context and culture is emphasised. Future research should focus on clarification studies informed by contemporary models of faculty development, in which factors impacting the health care workplace are considered.

Influencing factors in the implementation of postgraduate medical e-learning: a thematic analysis

BACKGROUND

Postgraduate medical e-learning (PGMeL) is being progressively used and evaluated. Its impact continues to grow, yet there are barriers to its implementation. Although more attention is now being paid to quality evaluation models, little has been written about the successful implementation of PGMeL. This study aims to determine factors and define themes influencing the successful implementation of PGMeL.

METHODS

We performed 10 semi-structured interviews with experienced e-learning creators, after which we carried out a thematic analysis to name and describe factors and themes.

RESULTS

Although this was not the objective of the study, the participants stressed the importance of a definition of success. Associated with this definition were: reaching your target audience, achieving learning aims, satisfying your audience and maintaining continuity. Three themes were identified containing eleven factors that influence successful implementation. The themes were named and defined after the group that had the most influence on the factors. We named them creator-, organization- and learner-dependent factors. The creator dependent factors are: the learning aim, pedagogical strategies, content expertise, evaluation and the creators motivational path. The organization dependent factors are management support, recourse and culture. Finally, the learner dependent factors are technology, motivators/barriers and value.

CONCLUSIONS

This study shows that implementing PGMeL has creator-, organization- and learner-dependent factors which should be taken into account during the creating of the PGMeL. Although creator- and learner-dependent factors are mentioned in other studies, the present study also stresses the importance of organization-dependent factors. Innovation implementation theories such as Rogers' diffusion of innovation or Kotter's eight steps of change management show a great overlap with these factors. Future studies can both evaluate the use of these innovation models in creating PGMeL and assess the effect of the organizational factors in greater depth.

Factors Influencing Technology Integration in the Curriculum for Taiwanese Health Profession Educators: A Mixed-Methods Study

In this study, we explored the considerations and the influencing factors for the technological integration of educational curricula based on the technological pedagogical content knowledge (TPCK) framework for health profession educators (HPEs). A mixed methodology was used that included semi-structured interviews with 15 HPEs and an online TPCK survey with a randomly selected sample of 319 HPEs from 217 Taiwanese universities. Five themes emerged, namely, supplementing traditional teaching methods, improving immediate educator–student interactions, tracking the learning process and improving the record-keeping, keeping up with technological trends, and advancing professional learning objectives for different student needs. The presence of pre-existing platforms and inspiration from colleagues and students were facilitators, whereas the risk of technological problems and the need to invest extra time into the preparation process were impediments to technology integration in the curriculum. Of the online respondents (n = 210), 64.2% have integrated at least one technological method into their curriculum. The logistic regression model revealed that gender, prior knowledge regarding how to incorporate technology with teaching, high mean TPCK scores, and relevant school policies were significant predictors of technology integration in the curriculum. Based on these results, recommendations for development in the health profession included efforts to equip HPEs with TPCK, in order to integrate technology into the curriculum effectively.

From Modules to MOOCs: Application of the Six-Step Approach to Online Curriculum Development for Medical Education

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.