JMIR医学教育

美国医科学生对医学人工智能的看法:混合方法调查研究

2022 - 10 - 21 - t09:46:40内

背景:鉴于人工智能在临床医学中的发展势头迅猛，当前的医生领导者呼吁在本科医学教育中更多地纳入人工智能主题。这是为了让未来的医生更好地与人工智能技术合作。然而，课程开发的第一步是调查最终用户的需求。目前还没有一项研究确定美国医科学生最喜欢哪种媒体和哪些主题来学习医学中的人工智能主题。目的:我们旨在调查美国医科学生在本科医学教育中纳入人工智能的必要性，以及他们首选的辅助未来教育举措的方式。2021年5月，Qualtrics向美国医科学生发送了一份混合方法调查，其中包括具体问题和书面回答部分。首先使用李克特量表问题来评估人工智能在医学领域的各种看法。针对人工智能的学习形式和主题提出了具体问题。结果:我们调查了来自17个不同医学项目的390名平均年龄为26岁(SD 3)的美国医科学生(估计应答率为3.5%)。大多数受访者(355/388,91.5%)同意在医学院接受人工智能概念的培训将对他们的未来有用。 While 79.4% (308/388) were excited to use artificial intelligence technologies, 91.2% (353/387) either reported that their medical schools did not offer resources or were unsure if they did so. Short lectures (264/378, 69.8%), formal electives (180/378, 47.6%), and Q and A panels (167/378, 44.2%) were identified as preferred formats, while fundamental concepts of artificial intelligence (247/379, 65.2%), when to use artificial intelligence in medicine (227/379, 59.9%), and pros and cons of using artificial intelligence (224/379, 59.1%) were the most preferred topics for enhancing their training. Conclusions: The results of this study indicate that current US medical students recognize the importance of artificial intelligence in medicine and acknowledge that current formal education and resources to study artificial intelligence–related topics are limited in most US medical schools. Respondents also indicated that a hybrid formal/flexible format would be most appropriate for incorporating artificial intelligence as a topic in US medical schools. Based on these data, we conclude that there is a definitive knowledge gap in artificial intelligence education within current medical education in the US. Further, the results suggest there is a disparity in opinions on the specific format and topics to be introduced.

谷歌图像搜索结果作为解剖实验室的资源:教育价值的评级

2022 - 10 - 21 - t09:30:03内

背景:临床前医学学习者嵌入在技术丰富的环境中，允许他们快速访问大量信息。解剖实验室是一个环境，教师可以评估专业技能的发展，如临床前医学学习者的信息素养。在解剖实验室，许多学生使用谷歌图像搜索除了或代替其他课程材料作为资源来定位和识别解剖结构。然而，最常见的来源以及这些图像的教育质量是未知的。目的:本研究旨在评估谷歌图像搜索结果中常用解剖结构的来源和教育价值。方法:收集39个解剖结构的前10个谷歌图像搜索结果。根据图片发布网站的目的和目标受众，对图片来源网站进行记录和分类。教育价值通过评估相关性(搜索结构是否在图像中描述?)、准确性(图像是否包含错误?)和有用性(图像是否有助于学习者在解剖供体上定位结构?)来确定。开发了一个可靠的评分标准来评估图像的有用性。结果:共分析390张图像。 Most often, images were sourced from websites targeting health care professionals and health care professions students (38% of images), while Wikipedia was the most frequent single source of image results (62/390 results). Of the 390 total images, 363 (93.1%) depicted the searched structure and were therefore considered relevant. However, only 43.0% (156/363) of relevant images met the threshold to be deemed useful in identifying the searched structure in an anatomical donor. The usefulness of images did not significantly differ across source categories. Conclusions: Anatomy faculty may use these results to develop interventions for gaps in information literacy in preclinical medical learners in the context of image searches in the anatomy laboratory.

COVID-19大流行两年后卫生专业人员的卫生素养:来自范围审查的结果

2022 - 10 - 17 - t09:45:02内

健康素养(HL)是一项重要的公共卫生目标，但对提供医疗服务的个人也至关重要。在大流行期间，与covid -19相关的卫生专业人员HL (HPs)有所增加;一方面，它有助于最大限度地降低自我感染的风险，另一方面，它有助于保护患者和亲属免受感染。然而，关于高危人群中个体大流行相关HL水平的全面信息很少。在本文中，我们旨在描述在COVID-19大流行(背景)中对高危人群(人群)进行的HL(概念)现有研究的程度。这篇综述的目的是绘制hp中HL的文献图，从而突出研究空白。本文采用Khalil等人(2016)的方法进行了范围综述。这包括PubMed (MEDLINE)和PsycInfo的电子搜索和手工搜索。对纳入的研究进行迭代检查，以找到代表获取，理解， 严格评估和应用与covid -19相关的健康信息的四个HL维度的项目。结果:搜索总共产生了3875条参考文献。 Only 7 (1.4%) of the 489 included studies explicitly stated to have addressed HL; 2 (0.4%) studies attempted to develop an instrument measuring COVID-19–related HL in HPs; 6 (1.2%) studies included an HL measure in an observational survey design. Of the remainder, the vast majority used a cross-sectional design. The dimensions access and understand were frequently examined, but few studies looked at the dimensions critical appraisal or apply. Very few studies reported an intervention aiming to improve a COVID-19–related HL outcome. Conclusions: High levels of COVID-19–related HL among HPs are necessary to ensure not only safe practice with necessary protection of HPs, their patients, and relatives, but also successful care delivery and subsequently improved health outcomes in the long term. To advance our understanding of how high COVID-19–related HL manifests itself in HPs, how it relates to health outcomes, and how it can be improved, more research is necessary. Trial Registration: Open Science Framework dbfa5; https://osf.io/dbfa5/

基于网络的、由教师主导的2型糖尿病继续医学教育项目的教育影响:一项分析卫生保健专业人员知识、能力和表现变化的调查研究

2022 - 10 - 14 - t09:45:02内

背景: 2型糖尿病(T2D)的治疗前景正在不断发展;因此，对卫生保健专业人员(HCPs)的持续教育是必不可少的。人们对衡量教育活动的影响越来越感兴趣，例如通过使用摩尔框架;然而，关于继续医学教育(CME)在T2D管理中的益处的数据仍然有限。目的:本研究旨在评估HCP满意度;衡量知识、能力，和短期、基于案例、多学科的基于web的CME活动;后的表现，并确定剩余的教育差距。两项由教师领导的、经医学会认证的关于T2D和肥胖的基于网络的教育活动，touchIN CONVERSATION和touch多学科团队，开发并在一个免费访问的医学教育网站上提供。每个活动包括3个视频，时长10到15分钟，内容是根据已发表的文献和教师反馈制定的学习目标。参与者满意度(Moore 2级)使用活动后问卷进行评估。对于这两项活动，在参加活动之前或之后，由有代表性的健康服务提供者填写问卷，评估知识和能力的变化(摩尔3级和4级)。 A second set of HCPs completed a questionnaire before and after engaging in activities that assessed changes in self-reported performance (Moore level 5). Results: Each activity was viewed by approximately 6000 participants within 6 months. The participants expressed high levels of satisfaction (>80%) with both activities. Statistically significant improvements from baseline in knowledge and competence were reported following participation in touchIN CONVERSATION (mean score, SD before vs after activity: 4.36, 1.40 vs 5.42, 1.37; P<.001), with the proportion of learners answering at least six of 7 questions correctly, increasing from 22% (11/50) to 60% (30/50). A nonsignificant improvement in knowledge and competence was observed following participation in touch MultiDisciplinary Team (mean score, SD 4.36, 1.24 vs 4.58, 1.07; P=.35); however, baseline knowledge and competence were relatively high, where 80% of the respondents (40/50) answered at least four of 6 questions correctly. A significant improvement in HCP self-reported performance was observed in a combined analysis of both activities (mean score, SD 2.65, 1.32 vs 3.15, 1.26; P=.03), with the proportion of learners selecting the answer representing the best clinical option for all 4 questions increasing from 32% (11/34) to 59% (20/34) after the activity. Several unmet educational needs were self-reported or identified from the analysis of incorrectly answered questions, including setting individualized glycemic targets and the potential benefits of sodium-glucose cotransporter 2 inhibitor therapies. Conclusions: Short, case-based, web-based CME activities designed for HCPs to fit their clinical schedules achieved improvements in knowledge, competence, and self-reported performance in T2D management. Ongoing educational needs identified included setting individualized glycemic targets and the potential benefits of sodium-glucose cotransporter 2 inhibitor therapies.

使用基于视频的沟通评估应用程序进行实践并获得众包反馈对住院医师不良事件沟通技能的影响:前后试验

2022 - 10 - 03 - t10:00:03内

背景:< strong>美国居民需要实践和反馈，以满足研究生医学教育认证委员会的要求和患者在有害错误后进行有效沟通的期望。目前的教学方法严重依赖于讲座，很少向住院医生提供关于沟通技巧的个性化反馈，并且可能无法确保住院医生获得患者所需的技能。基于视频的沟通评估(VCA)应用程序是一种新颖的工具，用于模拟实践中的沟通场景，并获得关于医生沟通技能的众包评估和反馈。我们之前已经确定，众包外行可以通过VCA应用程序可靠地评估住院医生的错误披露技能。然而，它对错误披露培训的有效性尚未经过测试。目的:我们旨在评估使用VCA实践和反馈作为独立干预对住院医师错误披露技能发展的效果。我们于2020年对美国一家学术医疗中心的病理学、妇产科和内科住院医师进行了一项前后研究。在基线时，每位居民完成了2例描述医疗错误的特定专业VCA病例。音频回答由至少8名众包外行使用6个项目(满分5分)对其进行评分。在第四周，住院医生收到了来自外行评分的数字和书面反馈，然后完成了另外两个案例。住院患者在基线和反馈评估后随机分配病例，以避免顺序影响。 Ratings were aggregated to create overall assessment scores for each resident at baseline and after feedback. Residents completed a survey of demographic characteristics. We used a 2×3 split-plot ANOVA to test the effects of time (pre-post) and specialty on communication ratings. Results: In total, 48 residents completed 2 cases at time 1, received a feedback report at 4 weeks, and completed 2 more cases. The mean ratings of residents’ communication were higher at time 2 versus time 1 (3.75 vs 3.53; P<.001). Residents with prior error disclosure experience performed better at time 1 compared to those without such experience (ratings: mean 3.63 vs mean 3.46; P=.02). No differences in communication ratings based on specialty or years in training were detected. Residents’ communication was rated higher for angry cases versus sad cases (mean 3.69 vs mean 3.58; P=.01). Less than half of all residents (27/62, 44%) reported prior experience with disclosing medical harm to patients; experience differed significantly among specialties (P<.001) and was lowest for pathology (1/17, 6%). Conclusions: Residents at all training levels can potentially improve error disclosure skills with VCA practice and feedback. Error disclosure curricula should prepare residents for responding to various patient affects. Simulated error disclosure may particularly benefit trainees in diagnostic specialties, such as pathology, with infrequent real-life error disclosure practice opportunities. Future research should examine the effectiveness, feasibility, and acceptability of VCA within a longitudinal error disclosure curriculum.

针对职业治疗学生和从业者的中风康复教育计划:可用性研究

2022 - 09 - 30 - t10:00:03内

背景:关于通过远程治疗进行中风评估和康复，当前循证实践的知识转化(KT)存在差距。缺乏这方面的知识可以阻止职业治疗(OT)学生和从业人员实施当前的研究成果。目的:本试点研究的目的是创建一个教育项目，将知识转化为实践，为OT学生和从业人员远程提供中风评估和康复。教育计划涉及四个重点领域，包括KT、任务导向培训、中风评估和远程康复。进行了两个试点研究，以评估通过知识的前测和后测获得的知识，然后是系统可用性量表和一般反馈问卷。研究1的参与者为5名OT从业者和1名OT助理。研究2的参与者是9名在读的OT学生。在4周的课程中，每周通过电子邮件向参与者发送4个1小时的模块，每个模块涵盖不同的主题(KT、任务导向训练、中风评估和远程康复)。初步结果采用描述性统计进行回顾。结果:学生和从业人员的知识分数都有所提高，结果具有统计学意义。 Most of the educational modules had an above-average score regarding value and positive feedback for the educational program as a whole from the participants. Conclusions: Overall, the results of this pilot study indicate that a web-based educational program is a valuable, informational method of increasing the translation of knowledge in the remote delivery of stroke assessment and rehabilitation. OT students and practitioners found the information presented to be valuable and relevant to their future profession and current practice.

电报在外科教育中的应用:探索性研究

2022 - 09 - 27 - t09:45:02内

背景: COVID-19大流行打乱了医学教育，使学习转向在线。包括即时通讯应用程序在内的社交媒体平台已经很好地融入了医学教育。然而，Telegram在医学教育中的作用仍相对未被探索。目的:本研究旨在探讨医学生对消息应用程序在医学教育中的作用的看法，以及他们使用Telegram进行外科教育的经验。方法:开设“外科学习与应用电报教育(TESLA)”电报频道，辅助医学生学习。我们邀请了13名加入TESLA频道至少一个月的医学生参加个人半结构化访谈。访谈使用访谈指南通过视频会议进行，然后由2名研究人员使用归纳主题内容分析进行转录和分析。结果:确定了两个主题:(1)作为医学生的学习和(2)移动学习(mLearning)在医学教育中的作用。学生们分享说，与大流行相关的安全措施，如减少诊所分配和无法在病房之间交叉，导致临床暴露减少。学生们越来越多地使用包括专有学习应用程序和即时通讯应用程序在内的移动应用程序来帮助学习。 Students favored Telegram over other messaging apps and reported the development of TESLA as beneficial, particularly for revision and increasing knowledge. Conclusions: The use of apps for medical education increased during the COVID-19 pandemic. Medical students commonly used apps to consolidate their learning and revise examination topics. They found TESLA useful, relevant, and trustworthy.

本科医学教育中的信息学:北美地区能力框架和实践分析

2022 - 09 - 13 - t10:00:37内

背景:随着以能力为基础的医学教育的出现，以及加拿大努力将临床信息学纳入本科医学教育，美国的能力框架没有强调与更广泛的医学实践相关的临床信息学相关的技能。通过研究加拿大和美国临床信息学本科医学教育的能力框架，我们假设存在差距:整个北美临床信息学教育缺乏统一的能力集和框架。我们在加拿大和美国研究生临床信息学能力与普通医学教育研究生能力之间进行了定向能力映射。在加拿大角色和美国通用项目需求之间使用子能力和使能能力级别的关键字匹配进行定向能力映射。此外，对于普通研究生医学教育能力，为医学教育联络委员会开发的医生能力参考集被用作计算能力框架之间本体重叠的直接手段。在通过本科和研究生医学教育能力框架将加拿大角色映射到美国能力之后，两个国家之间的重点差异可以从主题上描述为临床和管理推理概念之间的差异。结论:我们建议本科医学教育中信息学能力的发展或部署应集中在3个方面:诊断推理的教学，这样包括临床推理和管理推理的信息任务就可以讨论;精准医疗教育，信息学可以提供更细粒度的评估;以及支持传统教学努力的评估方法(包括在床边和其他地方)。使用案例或结构化评估进行评估(例如，客观结构化临床考试)将帮助学生在临床信息学和基础临床学科之间进行比较，并更好地强调通过信息学教授的认知技术。

医学学生和卫生保健专业人员在临床环境中采用电子健康的实践、感知益处和障碍:横断面调查研究

2022 - 09 - 13 - t10:00:03内

背景:电子保健正日益成为卫生实践和政策制定战略中不可或缺的一部分。然而，越南医学学生和卫生保健专业人员在临床实践中使用电子卫生工具以及对电子卫生的看法尚不清楚。目的:本研究旨在调查医学生和卫生保健专业人员对电子卫生及其相关因素的看法和实践。一项基于网络的横断面研究对523名医科学生和卫生保健专业人员进行了调查。收集了关于在临床实践中应用电子健康的实践、感知障碍和益处的信息。多变量Tobit和逻辑回归模型用于确定与感知和实践相关的因素。总体而言，61.6%(322/523)的参与者在临床实践中使用了电子健康工具，具有中等水平的电子健康素养。电子健康工具的感知益处得分很低。使用电子医疗最常见的障碍是IT人力资源(240/523,45.9%)，其次是安全和风险控制能力(226/523,43.2%)，以及没有电子医疗应用培训(223/523,42.6%)。年龄、电子健康素养以及使用互联网更新医学知识与在临床实践中使用电子健康工具呈正相关。 Conclusions: eHealth tools were moderately used in clinical practices, and the benefits of eHealth were underestimated among health care professionals and medical students in Vietnam. Renovating the current medical education curriculum to integrate eHealth principles should be required to equip health care professionals and medical students with essential skills for rapid digital transformation.

使用移动虚拟现实模拟准备亲自帮助婴儿呼吸训练:随机对照试验(eHBB/mHBS试验)的二次分析

2022 - 09 - 12 - t10:00:04内

新生儿死亡率约占全球5岁以下儿童死亡率的46%。在低收入和中等收入国家，移动设备的广泛使用使得移动虚拟现实(VR)等创新能够在卫生保健工作者的模拟教育中发挥作用。目的:本研究探讨了在新生儿复苏培训中使用移动VR进行课前准备的可行性和教育效果。在尼日利亚拉各斯和肯尼亚西部布西亚的20家二级和三级卫生保健机构的产科和新生儿护理单位的卫生保健专业人员，在过去1年内未接受过帮助婴儿呼吸(HBB)培训，随机进入电子HBB VR模拟和数字化HBB提供者指南(VR组)或仅使用数字化HBB提供者指南(对照组)。根据先前发表的主要研究方案计算出每组91名参与者的样本量。参与者被要求使用电子HBB VR模拟和数字化HBB提供者指南，或单独使用数字化HBB提供者指南至少20分钟。然后进行了HBB知识和技能评估，随后立即进行了由研究人员领导的标准现场HBB培训课程，使用标准的HBB评估工具和新生儿活体人体模型(Laerdal Medical)。结果:共有179名护士和助产士参与(VR组:n=91;对照组:n=88)。知识检查(P=.29)、气囊和面罩通气技能检查(P=.34)和客观结构化临床检查A检查表(P=.43)的总体表现得分在各组之间相似，总体通过率较低(6/178,3.4%的参与者)。 During the Objective Structured Clinical Examination A test, participants in the VR group performed better on the critical step of positioning the head and clearing the airway (VR group: 77/90, 86%; control group: 57/88, 65%; P=.002). The median percentage of ventilations that were performed via head tilt, as recorded by the Neonatalie Live manikin, was also numerically higher in the VR group (75%, IQR 9%-98%) than in the control group (62%, IQR 13%-97%), though not statistically significantly different (P=.35). Participants in the control group performed better on the identifying a helper and reviewing the emergency plan step (VR group: 7/90, 8%; control group: 16/88, 18%; P=.045) and the washing hands step (VR group: 20/90, 22%; control group: 32/88, 36%; P=.048). Conclusions: The use of digital interventions, such as mobile VR simulations, may be a viable approach to precourse preparation in neonatal resuscitation training for health care professionals in low- and middle-income countries.