Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Virtual Reality (VR) is a technology that allows the user to explore and manipulate computer-generated real or artificial three-dimensional (3D) multimedia sensory environments in real time to gain practical knowledge that can be used in clinical practice. Objective: The aim of this systematic review was to evaluate the effectiveness of virtual reality (VR) for educating health professions and improving their knowledge, cognitive skills, attitudes and satisfaction. Methods: We performed a systematic review of the effectiveness of virtual reality in pre- and post-registration health professions education following the gold standard Cochrane methodology. We searched seven databases from the year 1990 up to August 2017. No language restrictions were applied. We included randomized controlled trials and cluster-randomized trials. We independently selected studies, extracted data and assessed risk of bias, then compared the information in pairs. We contacted study authors for additional information if necessary. All pooled analyses were based on random-effects models. We used the GRADE approach to rate the quality of the body of evidence. Results: Thirty-one studies (N = 2407) were included. Meta-analysis of eight trials found that VR slightly improves post-intervention knowledge scores when compared with traditional learning (SMD = 0.44, 95% CI: 0.18, 0.69, I2 = 49%, N = 603) or to other types of digital education such as online or digital education (SMD = 0.43, 95% CI: 0.07, 0.79, I2 = 78%, N = 608, low certainty evidence). Another meta-analysis of four trials found that VR improves health professions cognitive skills when compared with traditional learning (SMD = 1.12, 95% CI: 0.81, 1.43, I2 = 0%, N = 235). Two studies compared VR to other forms of digital education on skills, favoring the VR group (SMD = 0.50, 95% CI: 0.32, 0.69, I2 = 0%, N = 467, moderate effect size, low certainty evidence). The findings for attitudes and satisfaction were mixed and inconclusive. No studies reported patient-related outcomes, behavior change or unintended/adverse effects of the VR. Overall, the certainty of evidence according to the GRADE criteria ranged from low to moderate. We downgraded our certainty of the evidence primarily because of the risk of bias and/or inconsistency. Conclusions: We found evidence suggesting that virtual reality improves post-intervention knowledge and skills outcomes of health professions when compared to traditional education or other types of digital education such as online or offline digital education. The findings on other outcomes are limited. Future research should evaluate more on the effectiveness of immersive and interactive forms of VR and evaluate other outcomes such as attitude, satisfaction, cost-effectiveness and clinical practice or behavior change.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Since the advent of artificial intelligence (AI) since 1955, the applications of artificial intelligence (AI) have risen over the years. However, there has been little interest in AI in medical education until the last two decades, with an increase in the number of publications and citations on the field. Currently to our knowledge, limited articles are discussing or reviewing the current use of AI in medical education. Objective: This study aims to review the current applications of AI in medical education, as well as the challenges of implementing AI in medical education. Methods: Medline (Ovid), EBSCOhost ERIC & Education Source and Web of Science were searched with explicit inclusion and exclusion criteria. Selected articles were analyzed in full-text using the Extension of Technology Acceptance Model (ETAM) and the Diffusions of Innovations (DOI) theory. Data was subsequently pooled together and analyzed quantitatively. Results: A total of 34 articles were identified; three primary uses of AI in medical education were identified: 1 on curriculum review, 29 on learning support, and four on assessment of students' learning. Thirty-one articles described the challenges of implementation of AI in medical education; two main reasons were identified: difficulty in assessing the effectiveness of AI in medical education, and technical challenges while developing the AI system. Conclusions: The primary use of AI in medical education was on learning support due to mainly its ability to provide individualized feedback. Little emphasis is placed on curriculum review and assessment of students' learning due to the lack of digitalization and sensitive nature of examinations respectively. Methodological improvements are required to increase the adoption of AI by addressing the technical difficulties of creating an AI system and using novel methods to assess the effectiveness of AI.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: There is a worldwide shortage of health workers, requiring innovative education solutions. Serious gaming and gamification education has the potential to provide a quality, cost-effective, novel approach, which is flexible, portable, enjoyable, and allows interaction with tutors and peers. Objective: The aim of this systematic review was to evaluate the effectiveness of serious gaming/gamification for health professions education compared with traditional learning, other types of digital education , or other serious gaming/gamification interventions, in terms of patient outcomes, knowledge, skills, professional attitudes and satisfaction (primary outcomes) and education economics outcomes and adverse events (secondary outcomes). Methods: A comprehensive search of MEDLINE, EMBASE, Web of Knowledge, Educational Resources Information Centre, Cochrane Central Register of Controlled Trials, PsycINFO and CINAHL from 1990 to August 2017 was conducted. Randomized controlled trials (RCTs) and cluster RCTs (cRCTs) were eligible for inclusion. Two reviewers independently searched, screened, assessed study quality and extracted data. Meta-analysis was not deemed appropriate due to heterogeneity of populations, interventions, comparisons and outcomes and a narrative synthesis is presented. Results: Twenty-seven RCTs and 3 cRCTs with 3634 participants were included. One study reported a small statistically significant difference between serious gaming and digital education for primary care physicians in time to blood pressure control among a subgroup of their patients already taking antihypertensive medications. There was evidence of moderate to large magnitude of effect from five studies evaluating individually delivered interventions for objectively measured knowledge compared with traditional learning. There was also evidence of small to large magnitude of effect from ten studies for improved skills compared with traditional learning. Two and four studies respectively suggested equivalence between interventions and controls. Evidence suggested serious gaming was at least as effective as other digital education modalities for these outcomes. There was insufficient evidence to conclude whether one type of serious gaming/gamification intervention is more effective than any other. There was limited evidence measuring effects on professional attitudes. Serious gaming/gamification may improve satisfaction but evidence was again limited. Evidence was low or very low quality for all outcomes. Quality of evidence was downgraded due to imprecision, inconsistency and study limitations. Conclusions: Serious gaming/gamification appears to be at least as effective as controls, and in many studies more effective, for improving knowledge, skills and satisfaction. However, the available evidence is mostly of low quality and calls for further rigorous, theory driven research.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Background. The effective development of healthcare competencies poses great educational challenges. A possible approach to provide learning opportunities is the use of augmented reality (AR) where virtual learning experiences can be embedded in a real physical context. The aim of this study was to provide a comprehensive overview of the current state of the art in terms of user acceptance, the AR applications developed and the effect of AR on the development of competencies in healthcare.Methods. We conducted an integrative review. Integrative reviews are the broadest type of research review methods allowing for the inclusion of various research designs to more fully understand a phenomenon of concern. Our review included multi-disciplinary research publications in English reported until 2012.Results. 2529 research papers were found from ERIC, CINAHL, Medline, PubMed, Web of Science and Springer-link. Three qualitative, 20 quantitative and 2 mixed studies were included. Using a thematic analysis, we’ve described three aspects related to the research, technology and education. This study showed that AR was applied in a wide range of topics in healthcare education. Furthermore acceptance for AR as a learning technology was reported among the learners and its potential for improving different types of competencies.Discussion. AR is still considered as a novelty in the literature. Most of the studies reported early prototypes. Also the designed AR applications lacked an explicit pedagogical theoretical framework. Finally the learning strategies adopted were of the traditional style ‘see one, do one and teach one’ and do not integrate clinical competencies to ensure patients’ safety.

The term “virtual patients” (VPs) has been used for many years in academic publications, but its meaning varies, leading to confusion. Our aim was to investigate and categorize the use of the term “virtual patient” and then classify its use in healthcare education. A literature review was conducted to determine all articles using the term “virtual patient” in the title or These articles were categorized into: Education, Clinical Procedures, Clinical Research and E-Health. All educational articles were further classified based on a framework published by Talbot et al. which was further developed using a deductive content analysis approach. 536 articles published between 1991 and December 2013 were included in the study. From these, 330 were categorized as educational. Classifying these showed that 37% articles used VPs in the form of Interactive Patient Scenarios. VPs in form of High Fidelity Software Simulations (19%) and Virtual Standardized Patients (16%) were also frequent. Less frequent were other forms, such as VP Games. Analyzing the literature across time shows an overall trend towards the use of Interactive Patient Scenarios as the predominant form of VPs in healthcare education. The main form of educational VPs in the literature are Interactive Patient Scenarios despite rapid technical advances that would support more complex applications. The adapted classification provides a valuable model for VP developers and researchers in healthcare education to more clearly communicate the type of VP they are addressing avoiding misunderstandings.