Hello COMSEP!
Calling out to you from the depths of winter with another edition of COMSEP Journal Club.
Perhaps appropriately, all of our reviews this month focus entirely or in-part on virtual education.
Hang in there—things surely will be looking up by next month. Right? Right?
Enjoy,
Amit, Karen and Jon
Beyond Beat Saber: virtual reality in health professional education
Virtual Reality for Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. Kyaw BM, Saxena N, Posadzki P, Vseteckova J, Nikolaou CK, George PP, Divakar U, Masiello I, Kononowicz AA, Zary N, Tudor Car L . J Med Internet Research 2019;21(1)e:12959. https://www.jmir.org/2019/1/e12959/
Reviewed by Kirstin Nackers
What was the study question?
What is the effectiveness of virtual reality (VR) for health professional education – knowledge, cognitive skills, attitudes and satisfaction?
How was the study done?
A systematic review was performed according to Cochrane review guidelines. This included a search of 7 databases from 1990 to August 2017, including randomized controlled trials and cluster-randomized trials comparing VR against other educational modalities. 30,0532 unique references were identified, independently reviewed by the authors, and ultimately 31 studies met the inclusion criteria. Data was extracted. Studies were then grouped by outcome and comparison for analysis.
What were the results?
Studies included a range of VR interventions including 3D models, simulated interactions with virtual patients and/or virtual health professionals, and surgical simulations. Controls included traditional learning methods and other digital education interventions.
VR showed slight improvement in knowledge acquisition compared to traditional (9 studies) and digital education (8 studies)
VR showed large improvements in skill acquisition compared to traditional learning (7 studies), and comparisons against digital learning (3 studies) still favored VR with greater effect with more interactive VR interventions.
Attitude and satisfaction outcomes showed little to no difference between VR and comparator educational methods.
There was insufficient evidence for secondary outcomes including cost/cost-efficiency, and patient related outcomes.
What are the implications?
Virtual reality is an emerging technology in health professional education and has the potential for a big “wow” factor when done well. This review has many limitations; two of the most significant are that available studies were from high-income countries only and assessed outcomes only immediately post-intervention. More research is needed. The resources needed to create VR educational activities will be a barrier for many individuals and institutions, but there is opportunity for a third-party to create a product that could be licensed for individual or institutional use in education.
Editor’s Note: This review only includes studies through 2017. The challenges of the pandemic and the recent focus on VR technology by major corporations like Facebook, Apple and Microsoft can only accelerate the process. It may soon be time to get your medical educator avatar ready. (JG)
Evaluation of a telemedicine course
Preparing Future Doctors for Telemedicine: An Asynchronous Curriculum for Medical Students Implemented During the COVID-19 Pandemic. Frankl SE, Joshi A, Onorato S, et al. Acad Med 2021; 96:1696-1701. https://dx.doi.org/10.1097/ACM.0000000000004260
Reviewed by Shanna Yue
What was the study question?
How does an asynchronous telemedicine curriculum for medical students impact their knowledge of telemedicine and the skills needed to conduct live video encounters?
How was it done?
The authors created a 5-module curriculum: 1) introduction to telemedicine and the impact of COVID-19 on telemedicine, 2) setting up the visit, 3) conducting a history and physical over the video, 4) observation of a telemedicine visit, and 5) small group discussions and final paper. Students had four weeks to complete the course, which was given asynchronously on an online learning platform at Harvard Medical School.
Each student completed a pre-course survey that self-assessed baseline knowledge and self-efficacy in telemedicine. Upon completing the course, they completed a post-course survey to assess any change in students’ perceived knowledge and self-efficacy in telemedicine visits and delivery method effectiveness and engagement of each module.
What were the results?
Two hundred fifty-two students participated in the curriculum, all 167 students in the clerkship year and 85/178 eligible post-clerkship students. All students completed the pre-course survey, and 216 (85.7%) completed the post-course survey. On average, students’ self-assessed knowledge over four domains increased. Thirty-eight (15.1%) reported being fairly/very knowledgeable before the course compared with 182 (84.3%) afterward. The course was highly rated, with 85.9% of students reporting that it met their learning needs and 81.5% finding the delivery method to be effective.
What are the implications?
As telemedicine becomes increasingly integrated into healthcare delivery systems, providing medical students with training in telemedicine is essential. This course demonstrates the effectiveness of an asynchronous telemedicine curriculum in increasing perceived knowledge and skills for telemedicine clinical encounters. The flexibility of an online asynchronous modality allows students to complete the course alongside other curricular demands and provides a generalizable model that can be implemented at other institutions.
Editor’s Note: The authors of this study did a good job of collecting surveys to get over an 80% response rate. However this study only measures self-rated knowledge and skills. It is unknown if students would be able to apply what they learned in this course. (AP)
Soon-to-be residents learn about social determinants of health
“TEACH”ing Medical Students to Address Child Poverty: A Multimodal Curriculum
Weisz J, Magee P, Clarence I, et al. Academic Pediatrics 2022;22:168-170. DOI: https://doi.org/10.1016/j.acap.2021.05.011
Reviewed by Bridget Gibson
What was the study question?
Does a multimodal curriculum on the health effects of child poverty change knowledge, attitudes, and confidence of fourth-year medical students in identifying and addressing poverty in their patients’ families?
How was it done?
The Trainee Education in Advocacy and Community Health (TEACH) curriculum was designed based on the US Child Poverty Curriculum learning objectives to identify and address health effects of child poverty. The curriculum included interactive online modules, an application for government benefits, videos about evictions, community-based experiential learning, and a group reflection session. Forty fourth year medical students planning to enter primary care specialties completed the curriculum. Pre- and post-curriculum multiple choice questions assessed knowledge gained and change in attitudes on screening and addressing Social Determinants of Health. A post-curriculum survey assessed changes in student’s confidence in addressing the learning objectives. Themes from the reflection sessions were identified.
What were the results?
Overall, the TEACH curriculum increased students’ knowledge and confidence in identifying and addressing child poverty with a statistically significant increase in knowledge between the pre- and post-curriculum test, attitudes toward being well prepared to address financial and related social needs for patients’ families, and increased confidence in addressing 6 of the 7 learning objectives. Although not statistically significant, attitudes around the feasibility, importance, and effectiveness at addressing financial and related social needs improved. Themes that emerged from reflection sessions highlighted that the curriculum was effective in challenging misconceptions, developing empathy, and increasing familiarity with the available resources.
What are the implications?
Identifying child poverty, empathizing with families, and knowing how to effectively direct families toward resources can be an overwhelming and challenging task for physicians. By increasing knowledge and confidence in this area early in training, future physicians may be more effective at addressing the social determinants of health with their patients’ families.
Editor’s Note: This 2-day curriculum was part of a “Transition to Residency” rotation; it would be interesting to see if the findings would be similar if the curriculum was instead delivered in the “Transition to Clerkship”. This would then allow students to have more opportunities to apply what they have learned with real patients during their clerkship experiences, furthering their experiential learning (KFo).