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Author: Brian S McGowan, PhD

ABSTRACT: InsuOnline, a Serious Game to Teach Insulin Therapy to Primary Care Physicians: Design of the Game and a Randomized Controlled Trial for Educational Validation.

Abstract
BACKGROUND:
Physicians´ lack of knowledge contributes to underuse of insulin and poor glycemic control in adults with diabetes mellitus (DM). Traditional continuing medical education have limited efficacy, and new approaches are required.
OBJECTIVE:
We report the design of a trial to assess the educational efficacy of InsuOnline, a game for education of primary care physicians (PCPs). The goal of InsuOnline was to improve appropriate initiation and adjustment of insulin for the treatment of DM. InsuOnline was designed to be educationally adequate, self-motivating, and attractive.
METHODS:
A multidisciplinary team of endocrinologists, experts in medical education, and programmers, was assembled for the design and development of InsuOnline. Currently, we are conducting usability and playability tests, with PCPs and medical students playing the game on a desktop computer. Adjustments will be made based on these results. An unblinded randomized controlled trial with PCPs who work in the city of Londrina, Brazil, will be conducted to assess the educational validity of InsuOnline on the Web. In this trial, 64 PCPs will play InsuOnline, and 64 PCPs will undergo traditional instructional activities (lecture and group discussion). Knowledge on how to initiate and adjust insulin will be assessed by a Web-based multiple choice questionnaire, and attitudes regarding diabetes/insulin will be assessed by Diabetes Attitude Scale 3 at 3 time points-before, immediately after, and 6 months after the intervention. Subjects´ general impressions on the interventions will be assessed by a questionnaire. Software logs will be reviewed.
RESULTS:
To our knowledge, this is the first research with the aim of assessing the educational efficacy of a computer game for teaching PCPs about insulin therapy in DM. We describe the development criteria used for creating InsuOnline. Evaluation of the game using a randomized controlled trial design will be done in future studies.
CONCLUSIONS:
We demonstrated that the design and development of a game for PCPs education on insulin is possible with a multidisciplinary team. InsuOnline can be an attractive option for large-scale continuous medical education to help improving PCPs´ knowledge on insulin therapy and potentially improving DM patients´ care.

via InsuOnline, a Serious Game to Teach Insulin … [JMIR Res Protoc. 2013] – PubMed – NCBI.

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ABSTRACT: Development of National Competency-based Learning Objectives “Medical Informatics” for Undergraduate Medical Education.

Abstract
Objectives: The aim of this project is to develop a catalogue of competency-based learning objectives “Medical Informatics” for undergraduate medical education (abbreviated NKLM-MI in German). Methods: The development followed a multi-levelannotation andconsensus process. For each learning objective a reason why a physician needs this competence was required. In addition, each objective was categorized according to the competence context (A = covered by medical informatics, B = core subject of medical informatics, C = optional subject of medical informatics), the competence level (1 = referenced knowledge, 2 = applied knowledge, 3 = routine knowledge) and a CanMEDS competence role (medical expert, communicator, collaborator, manager, health advocate, professional, scholar). Results: Overall 42 objectives in seven areas (medical documentation and information processing, medical classifications and terminologies, information systems in healthcare, health telematics and telemedicine, data protection and security, access to medical knowledge and medical signal-/image processing) were identified, defined and consented. Conclusion: With the NKLM-MI the competences in the field of medical informatics vital to a first year resident physician are identified, defined and operationalized. These competencies are consistent with the recommendations of the International Medical Informatics Association (IMIA). The NKLM-MI will be submitted to the National Competence-Based Learning Objectives for Undergraduate Medical Education. The next step is implementation of these objectives by the faculties.

via Development of National Competency-based Lea… [Methods Inf Med. 2013] – PubMed – NCBI.

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ABSTRACT: eLearning among Canadian anesthesia residents: a survey of podcast use and content needs.

Abstract
BACKGROUND:
Podcasts are increasingly being used in medical education. In this study, we conducted a survey of Canadian anesthesia residents to better delineate the content needs, format preferences, and usage patterns among anesthesia residents METHODS: 10/16 Canadian anesthesia program directors, representing 443/659 Canadian anesthesia residents, allowed their residents to be included in the study. 169/659 (24%) residents responded to our survey. A 17-item survey tool developed by the investigators was distributed by email eliciting information on patterns of podcast use, preferred content, preferred format, and podcast adjuncts perceived to increase knowledge retention.
RESULTS:
60% (91/151) had used medical podcasts with 67% of these users spending up to 1 hour per week on podcasts. 72.3% of respondents selected ‘ability to review materials whenever I want’ was selected by the majority of respondents (72%) as the reason they found podcasts to be valuable. No clear preference was shown for audio, video, or slidecast podcasts. Physiology (88%) and pharmacology (87%) were the most requested basic science topics while regional anesthesia (84%), intensive care (79%) and crisis resource management (86%) were the most requested for procedural, clinical and professional topics respectively. Respondents stated they would most likely view podcasts that contained procedural skills, journal article summaries and case presentations and that were between 5-15 minutes in duration A significantly greater proportion of senior residents (81%) requested podcasts on ‘pediatric anesthesia’ compared to junior residents 57% (P = 0.007).
CONCLUSIONS:
The majority of respondents are using podcasts. Anesthesia residents have preferred podcast content, types, length and format that educators should be cognizant of when developing and providing podcasts.

via eLearning among Canadian anesthesia residents: … [BMC Med Educ. 2013] – PubMed – NCBI.

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ABSTRACT: A Crowdsourcing Model for Creating Preclinical Medical Education Study Tools.

Abstract
During their preclinical course work, medical students must memorize and recall substantial amounts of information. Recent trends in medical education emphasize collaboration through team-based learning. In the technology world, the trend toward collaboration has been characterized by the crowdsourcing movement. In 2011, the authors developed an innovative approach to team-based learning that combined students’ use of flashcards to master large volumes of content with a crowdsourcing model, using a simple informatics system to enable those students to share in the effort of generating concise, high-yield study materials. The authors used Google Drive and developed a simple Java software program that enabled students to simultaneously access and edit sets of questions and answers in the form of flashcards. Through this crowdsourcing model, medical students in the class of 2014 at the Johns Hopkins University School of Medicine created a database of over 16,000 questions that corresponded to the Genes to Society basic science curriculum. An analysis of exam scores revealed that students in the class of 2014 outperformed those in the class of 2013, who did not have access to the flashcard system, and a survey of students demonstrated that users were generally satisfied with the system and found it a valuable study tool. In this article, the authors describe the development and implementation of their crowdsourcing model for creating study materials, emphasize its simplicity and user-friendliness, describe its impact on students’ exam performance, and discuss how students in any educational discipline could implement a similar model of collaborative learning.

via A Crowdsourcing Model for Creating Preclinical Medi… [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: I’m Clear, You’re Clear, We’re All Clear: Improving Consultation Communication Skills in Undergraduate Medical Education.

Abstract
Requesting and providing consultations are daily occurrences in most teaching hospitals. With increased attention on transitions of care in light of the recent scrutiny of duty hours, consultations and other interphysician interactions, such as handoffs, are becoming increasingly important. As modern medicine increases in complexity, the skill of communicating with medical colleagues throughout the continuum of care becomes more challenging. Like many of the other skills acquired by medical students, consultation communication is often learned by casual observation and through trial and error. Without formal training, however, miscommunications will continue to occur, nearly ensuring that medical errors happen. Interphysician communication skills, therefore, need to be emphasized in undergraduate and graduate medical education instead of being left to happenstance or hit-or-miss practice. In this article, the authors review two models for understanding and teaching the consultation process-5Cs and PIQUED-both of which were developed for specific subsets of learners. They then combine the two to create a consultation model that may be more widely applied.

via I’m Clear, You’re Clear, We’re All Clear: Improving… [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: Technology-Enhanced Simulation to Assess Health Professionals: A Systematic Review of Validity Evidence, Research Methods, and Reporting Quality.

Abstract
PURPOSE:
To summarize the tool characteristics, sources of validity evidence, methodological quality, and reporting quality for studies of technology-enhanced simulation-based assessments for health professions learners.
METHOD:
The authors conducted a systematic review, searching MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, Scopus, key journals, and previous reviews through May 2011. They selected original research in any language evaluating simulation-based assessment of practicing and student physicians, nurses, and other health professionals. Reviewers working in duplicate evaluated validity evidence using Messick’s five-source framework; methodological quality using the Medical Education Research Study Quality Instrument and the revised Quality Assessment of Diagnostic Accuracy Studies; and reporting quality using the Standards for Reporting Diagnostic Accuracy and Guidelines for Reporting Reliability and Agreement Studies.
RESULTS:
Of 417 studies, 350 (84%) involved physicians at some stage in training. Most focused on procedural skills, including minimally invasive surgery (N = 142), open surgery (81), and endoscopy (67). Common elements of validity evidence included relations with trainee experience (N = 306), content (142), relations with other measures (128), and interrater reliability (124). Of the 217 studies reporting more than one element of evidence, most were judged as having high or unclear risk of bias due to selective sampling (N = 192) or test procedures (132). Only 64% proposed a plan for interpreting the evidence to be presented (validity argument).
CONCLUSIONS:
Validity evidence for simulation-based assessments is sparse and is concentrated within specific specialties, tools, and sources of validity evidence. The methodological and reporting quality of assessment studies leaves much room for improvement.

via Technology-Enhanced Simulation to Assess Health Pro… [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: Medical Education in the Electronic Medical Record (EMR) Era: Benefits, Challenges, and Future Directions

Abstract
In the last decade, electronic medical record (EMR) use in academic medical centers has increased. Although many have lauded the clinical and operational benefits of EMRs, few have considered the effect these systems have on medical education. The authors review what has been documented about the effect of EMR use on medical learners through the lens of the Accreditation Council for Graduate Medical Education’s six core competencies for medical education. They examine acknowledged benefits and educational risks to use of EMRs, consider factors that promote their successful use when implemented in academic environments, and identify areas of future research and optimization of EMRs’ role in medical education.

via Medical Education in the Electronic Medical Record … [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: Metric-based simulation training to proficiency in medical education:- What it is and how to do it.

Abstract
High profile error cases and reduced work hours have forced medicine to consider new approaches to training. Simulation-based learning for the acquisition and maintenance of skills has a growing role to play. Considerable advances have been made during the last 20 years on how simulation should be used optimally. Simulation is also more than a technology learning experience for supplanting the traditional approach of repeated practice. Research has shown that simulation works best when it is integrated into a curriculum. Learning is optimal when trainees receive metric-based feedback on their performance. Metrics should unambiguously characterize important aspects of procedure or skill performance. They are developed from a task analysis of the procedure or skills to be learned. The outcome of the task analysis should also shape how the simulation looks and behaves. Metric-based performance characterization can be used to establish a benchmark i.e., a level of proficiency which trainees must demonstrate before training progression. This approach ensures a more homogeneous skill-set in graduating trainees and can be applied to any level of training. Prospective, randomized and blinded clinical studies have shown that trainees who acquired their skills to a level of proficiency on a simulator in the skills laboratory perform significantly better in vivo in comparison to their traditionally trained colleagues. The Food and Drug Administration in the USA and the Department of Health in the UK have candidly indicated that they see an emergent and fundamental role for simulation-based training. Although a simulation-based approach to medical education and training may be conceptually and intellectually appealing it represents a paradigm shift in how doctors are educated and trained.

via Metric-based simulation training to proficiency… [Ulster Med J. 2012] – PubMed – NCBI.

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ABSTRACT: Leveraging Social Networks for Toxicovigilance

Abstract
The landscape of drug abuse is shifting. Traditional means of characterizing these changes, such as national surveys or voluntary reporting by frontline clinicians, can miss changes in usage the emergence of novel drugs. Delays in detecting novel drug usage patterns make it difficult to evaluate public policy aimed at altering drug abuse. Increasingly, newer methods to inform frontline providers to recognize symptoms associated with novel drugs or methods of administration are needed. The growth of social networks may address this need. The objective of this manuscript is to introduce tools for using data from social networks to characterize drug abuse. We outline a structured approach to analyze social media in order to capture emerging trends in drug abuse by applying powerful methods from artificial intelligence, computational linguistics, graph theory, and agent-based modeling. First, we describe how to obtain data from social networks such as Twitter using publicly available automated programmatic interfaces. Then, we discuss how to use artificial intelligence techniques to extract content useful for purposes of toxicovigilance. This filtered content can be employed to generate real-time maps of drug usage across geographical regions. Beyond describing the real-time epidemiology of drug abuse, techniques from computational linguistics can uncover ways that drug discussions differ from other online conversations. Next, graph theory can elucidate the structure of networks discussing drug abuse, helping us learn what online interactions promote drug abuse and whether these interactions differ among drugs. Finally, agent-based modeling relates online interactions to psychological archetypes, providing a link between epidemiology and behavior. An analysis of social media discussions about drug abuse patterns with computational linguistics, graph theory, and agent-based modeling permits the real-time monitoring and characterization of trends of drugs of abuse. These tools provide a powerful complement to existing methods of toxicovigilance.

via Leveraging Social Networks for Toxicovigilance. [J Med Toxicol. 2013] – PubMed – NCBI.

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MANUSCRIPT: Social Media Use in Medical Education: A Systematic Review

Purpose: The authors conducted a systematic review of the published literature on social media use in medical education to answer two questions: (1) How have interventions using social media tools affected outcomes of satisfaction, knowledge, attitudes, and skills for physicians and physicians-in-training? and (2) What challenges and opportunities specific to social media have educators encountered in implementing these interventions?

Method: The authors searched the MEDLINE, CINAHL, ERIC, Embase, PsycINFO, ProQuest, Cochrane Library, Web of Science, and Scopus databases (from the start of each through September 12, 2011) using keywords related to social media and medical education. Two authors independently reviewed the search results to select peer-reviewed, English-language articles discussing social media use in educational interventions at any level of physician training. They assessed study quality using the Medical Education Research Study Quality Instrument.

Results: Fourteen studies met inclusion criteria. Interventions using social media tools were associated with improved knowledge (e.g., exam scores), attitudes (e.g., empathy), and skills (e.g., reflective writing). The most commonly reported opportunities related to incorporating social media tools were promoting learner engagement (71% of studies), feedback (57%), and collaboration and professional development (both 36%). The most commonly cited challenges were technical issues (43%), variable learner participation (43%), and privacy/security concerns (29%). Studies were generally of low to moderate quality; there was only one randomized controlled trial.

Conclusions: Social media use in medical education is an emerging field of scholarship that merits further investigation. Educators face challenges in adapting new technologies, but they also have opportunities for innovation.

Social Media Use in Medical Education - A Systematic Review

via Social Media Use in Medical Education: A Systematic Review : Academic Medicine.

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