Teaching the content of clinical practice guidelines (CPGs) is important to both clinical care and graduate medical education. The objective of this study was to determine the characteristics of curricula for teaching the content of CPGs in family medicine and internal medicine residency programs in the United States.
We surveyed the directors of family medicine and internal medicine residency programs in the United States. The questionnaire included questions about the characteristics of the teaching of CPGs: goals and objectives, educational activities, evaluation, aspects of CPGs that the program teaches, the methods of making texts of CPGs available to residents, and the major barriers to teaching CPGs.
Of 434 programs responding (out of 839, 52%), 14% percent reported having written goals and objectives related to teaching CPGs. The most frequently taught aspect was the content of specific CPGs (76%). The top two educational strategies used were didactic sessions (76%) and journal clubs (64%). Auditing for adherence by residents was the primary evaluation strategy (44%), although 36% of program directors conducted no evaluation. Programs made texts of CPGs available to residents most commonly in the form of paper copies (54%) while the most important barrier was time constraints on faculty (56%).
Residency programs teach different aspects of CPGs to varying degrees, and the majority uses educational strategies not supported by research evidence.
The evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States.
We conducted a survey of family medicine and internal medicine residency program directors in the United States. The questionnaire asked the program directors whether they supported the use of educational games, their actual use of games, and the type of games being used and the purpose of that use.
Of 434 responding program directors (52% response rate), 92% were in support of the use of games as an educational strategy, and 80% reported already using them in their programs. Jeopardy like games were the most frequently used games (78%). The use of games was equally popular in family medicine and internal medicine residency programs and popularity was inversely associated with more than 75% of residents in the program being International Medical Graduates. The percentage of program directors who reported using educational games as teaching tools, review tools, and evaluation tools were 62%, 47%, and 4% respectively.
Given a widespread use of educational games in the training of medical residents, in spite of limited evidence for efficacy, further evaluation of the best approaches to education games should be explored.
To integrate a series of educational strategies ranging from content delivery to assessment, including a change in philosophy regarding the use of in-class time, to enhance learning of pharmacokinetics.
Several approaches were taken to develop a significant learning experience in the basic and clinical pharmacokinetics courses including games, a piloted multimedia module to offset content delivery and free-up class time, reflective writing, and an immediate feedback assessment. Games, a multimedia module, reflective writing assignments, and other innovative learning tools were incorporated into pharmacokinetics courses, as well as an assessment tool to provide immediate feedback.
Median examination scores did not improve following the incorporation of the teaching innovations; however, based on survey results, student satisfaction increased.
Already high median examination scores (>90% from historical controls) did not improve; however, the effectiveness of the innovations implemented, which included deep learning and critical thinking and communication skills, may be more accurately measured over the long term, eg, in performance in advanced pharmacy practice experiences.
multimedia; reflective writing; games; pharmacokinetics
There are no nationwide data on the methods residency programs are using to assess trainee competence. The Accreditation Council for Graduate Medical Education (ACGME) has recommended tools that programs can use to evaluate their trainees. It is unknown if programs are adhering to these recommendations.
To describe evaluation methods used by our nation’s internal medicine residency programs and assess adherence to ACGME methodological recommendations for evaluation.
All internal medicine programs registered with the Association of Program Directors of Internal Medicine (APDIM).
Descriptive statistics of programs and tools used to evaluate competence; compliance with ACGME recommended evaluative methods.
The response rate was 70%. Programs were using an average of 4.2–6.0 tools to evaluate their trainees with heavy reliance on rating forms. Direct observation and practice and data-based tools were used much less frequently. Most programs were using at least 1 of the Accreditation Council for Graduate Medical Education (ACGME)’s “most desirable” methods of evaluation for all 6 measures of trainee competence. These programs had higher support staff to resident ratios than programs using less desirable evaluative methods.
Residency programs are using a large number and variety of tools for evaluating the competence of their trainees. Most are complying with ACGME recommended methods of evaluation especially if the support staff to resident ratio is high.
graduate medical education; residency; ACGME; competency
Preparing medical students for the takeover or the start-up of a medical practice is an important challenge in Germany today. Therefore, this paper presents a computer-aided serious game (eMedOffice) developed and currently in use at the RWTH Aachen University Medical School. The game is part of the attempt to teach medical students the organizational and conceptual basics of the medical practice of a general practitioner in a problem-based learning environment. This paper introduces methods and concepts used to develop the serious game and describes the results of an evaluation of the game's application in curricular courses at the Medical School.
Results of the conducted evaluation gave evidence of a positive learning effect of the serious game. Educational supervisors observed strong collaboration among the players inspired by the competitive gaming aspects. In addition, an increase in willingness to learn and the exploration of new self-invented ideas were observed and valuable proposals for further prospective enhancements were elicited. A statistical analysis of the results of an evaluation provided a clear indication of the positive learning effect of the game. A usability questionnaire survey revealed a very good overall score of 4.07 (5=best, 1=worst).
We consider web-based, collaborative serious games to be a promising means of improving medical education. The insights gained by the implementation of eMedOffice will promote the future development of more effective serious games for integration into curricular courses of the RWTH Aachen University Medical School.
Computer-Assisted Instruction/methods; Games, Experimental; Teaching/methods, Education, Medical; Undergraduate/methods; User-Computer Interface
To evaluate family physicians’ enjoyment of and knowledge gained from game-based learning, compared with traditional case-based learning, in a continuing medical education (CME) event on stroke prevention and management.
An equivalence trial to determine if game-based learning was as effective as case-based learning in terms of attained knowledge levels. Game questions and small group cases were developed. Participants were randomized to either a game-based or a case-based group and took part in the event.
Ontario provincial family medicine conference.
Thirty-two family physicians and 3 senior family medicine residents attending the conference.
Participation in either a game-based or a case-based CME learning group.
MAIN OUTCOME MEASURES
Scores on 40-item immediate and 3-month posttests of knowledge and a satisfaction survey.
Results from knowledge testing immediately after the event and 3 months later showed no significant difference in scoring between groups. Participants in the game-based group reported higher levels of satisfaction with the learning experience.
Games provide a novel way of organizing CME events. They might provide more group interaction and discussion, as well as improve recruitment to CME events. They might also provide a forum for interdisciplinary CME. Using games in future CME events appears to be a promising approach to facilitate participant learning.
Despite many efforts at developing relapse prevention interventions, most smokers relapse to tobacco use within a few months after quitting. Interactive games offer a novel strategy for helping people develop the skills required for successful tobacco cessation.
The objective of our study was to develop a video game that enables smokers to practice strategies for coping with smoking urges and maintaining smoking abstinence. Our team of game designers and clinical psychologists are creating a video game that integrates the principles of smoking behavior change and relapse prevention. We have reported the results of expert and end-user feedback on an alpha version of the game.
The alpha version of the game consisted of a smoking cue scenario often encountered by smokers. We recruited 5 experts in tobacco cessation research and 20 current and former smokers, who each played through the scenario. Mixed methods were used to gather feedback on the relevance of cessation content and usability of the game modality.
End-users rated the interface from 3.0 to 4.6/5 in terms of ease of use and from 2.9 to 4.1/5 in terms of helpfulness of cessation content. Qualitative themes showed several user suggestions for improving the user interface, pacing, and diversity of the game characters. In addition, the users confirmed a high degree of game immersion, identification with the characters and situations, and appreciation for the multiple opportunities to practice coping strategies.
This study highlights the procedures for translating behavioral principles into a game dynamic and shows that our prototype has a strong potential for engaging smokers. A video game modality exemplifies problem-based learning strategies for tobacco cessation and is an innovative step in behavioral management of tobacco use.
smoking cessation; health promotion game; tobacco, quitting self efficacy; behavioral medicine; virtual reality
Risk-stratified treatment recommendations facilitate treatment decision-making that balances patient-specific risks and preferences. It is unclear if and how such recommendations are developed in clinical practice guidelines (CPGs). Our aim was to assess if and how CPGs develop risk-stratified treatment recommendations for the prevention or treatment of common chronic diseases.
We searched the United States National Guideline Clearinghouse for US, Canadian and National Institute for Health and Clinical Excellence (United Kingdom) CPGs for heart disease, stroke, cancer, chronic obstructive pulmonary disease and diabetes that make risk-stratified treatment recommendations. We included only those CPGs that made risk-stratified treatment recommendations based on risk assessment tools. Two reviewers independently identified CPGs and extracted information on recommended risk assessment tools; type of evidence about treatment benefits and harms; methods for linking risk estimates to treatment evidence and for developing treatment thresholds; and consideration of patient preferences.
We identified 20 CPGs that made risk-stratified treatment recommendations out of 133 CPGs that made any type of treatment recommendations for the chronic diseases considered in this study. Of the included 20 CPGs, 16 (80%) used evidence about treatment benefits from randomized controlled trials, meta-analyses or other guidelines, and the source of evidence was unclear in the remaining four (20%) CPGs. Nine CPGs (45%) used evidence on harms from randomized controlled trials or observational studies, while 11 CPGs (55%) did not clearly refer to harms. Nine CPGs (45%) explained how risk prediction and evidence about treatments effects were linked (for example, applying estimates of relative risk reductions to absolute risks), but only one CPG (5%) assessed benefit and harm quantitatively and three CPGs (15%) explicitly reported consideration of patient preferences.
Only a small proportion of CPGs for chronic diseases make risk-stratified treatment recommendations with a focus on heart disease and stroke prevention, diabetes and breast cancer. For most CPGs it is unclear how risk-stratified treatment recommendations were developed. As a consequence, it is uncertain if CPGs support patients and physicians in finding an acceptable benefit- harm balance that reflects both profile-specific outcome risks and preferences.
Cancer; cardiovascular disease; chronic disease; COPD; diabetes; guidelines; randomized trials; risk assessment; stroke; treatment
This study investigated the knowledge gains and attitude shifts attributable to a unique online science education game, Uncommon Scents. The game was developed to teach middle school students about the biological consequences of exposure to toxic chemicals in an environmental science context, as well as the risks associated with abusing these chemicals as inhalants. Middle school students (n = 444) grades six through eight participated in the study consisting of a pre-test, three game-play sessions, and a delayed post-test. After playing the game, students demonstrated significant gains in science content knowledge, with game usability ratings emerging as the strongest predictor of post-test content knowledge scores. The intervention also resulted in a shift to more negative attitudes toward inhalants, with the most negative shift occurring among eighth grade students and post-test knowledge gains as the strongest predictor of attitude change across all grade levels. These findings suggest that the environmental science approach used in Uncommon Scents is an efficacious strategy for delivering both basic science content and influencing perceived harm relating to the inhalation of toxic chemicals from common household products.
Game-based learning; Science-based drug education; Environmental education; Toxic chemicals; Body pollution; Attitudes toward inhalants; Video game
Games that use brainwaves via brain–computer interface (BCI) devices, to improve brain functions are known as BCI serious games. Due to the difficulty of developing BCI serious games, various BCI engines and authoring tools are required, and these reduce the development time and cost. However, it is desirable to reduce the amount of technical knowledge of brain functions and BCI devices needed by game developers. Moreover, a systematic BCI serious game development process is required. In this paper, we present a methodology for the development of BCI serious games. We describe an architecture, authoring tools, and development process of the proposed methodology, and apply it to a game development approach for patients with mild cognitive impairment as an example. This application demonstrates that BCI serious games can be developed on the basis of expert-verified theories.
BCI (brain–computer interface) sensors; BCI serious games; BCI framework; brainwaves
Researchers are developing sophisticated games specifically targeted to teach health-related knowledge and skills and to change health-related behaviors. Although these interventions, generally called “serious games,” show promise, there has been limited evaluation of their effectiveness. This article offers a broad “consumer guide” for evaluating such health education interventions. Improving the development and evaluation of healthrelated serious games and educating potential purchasers of such products to be knowledgeable, demanding consumers will help move the field of serious games from “looks promising” to determining where such interventions will be effective and where they will not.
We investigated the feasibility of using the Space Fortress (SF) game, a complex video game originally developed to study complex skill acquisition in young adults, to improve executive control processes in cognitively healthy older adults. The study protocol consisted of 36 one-hour game play sessions over 3 months with cognitive evaluations before and after, and a follow-up evaluation at 6 months. Sixty participants were randomized to one of three conditions: Emphasis Change (EC) – elders were instructed to concentrate on playing the entire game but place particular emphasis on a specific aspect of game play in each particular game; Active Control (AC) – game play with standard instructions; Passive Control (PC) – evaluation sessions without game play. Primary outcome measures were obtained from five tasks, presumably tapping executive control processes. A total of 54 older adults completed the study protocol. One measure of executive control, WAIS-III letter–number sequencing, showed improvement in performance from pre- to post-evaluations in the EC condition, but not in the other two conditions. These initial findings are modest but encouraging. Future SF interventions need to carefully consider increasing the duration and or the intensity of the intervention by providing at-home game training, reducing the motor demands of the game, and selecting appropriate outcome measures.
Aging; Cognition; Intervention; Executive control; Video games
Digital technologies can improve student interest and knowledge in science. However, researching the vast number of websites devoted to science education and integrating them into undergraduate curricula is time-consuming. We developed an Adobe ColdFusion– and Adobe Flash–based system for simplifying the construction, use, and delivery of electronic educational materials in science. The Online Multimedia Teaching Tool (OMTT) in Neuroscience was constructed from a ColdFusion-based online interface, which reduced the need for programming skills and the time for curriculum development. The OMTT in Neuroscience was used by faculty to enhance their lectures in existing curricula. Students had unlimited online access to encourage user-centered exploration. We found the OMTT was rapidly adapted by multiple professors, and its use by undergraduate students was consistent with the interpretation that the OMTT improved performance on exams and increased interest in the field of neuroscience.
There is an increasing interest in health games including simulation tools, games for specific conditions, persuasive games to promote a healthy life style or exergames where physical exercise is used to control the game.
The objective of the article is to review current literature about available health games and the impact related to game design principles as well as some educational theory aspects.
Literature from the big databases and known sites with games for health has been searched to find articles about games for health purposes. The focus has been on educational games, persuasive games and exergames as well as articles describing game design principles.
The medical objectives can either be a part of the game theme (intrinsic) or be totally dispatched (extrinsic), and particularly persuasive games seem to use extrinsic game design. Peer support is important, but there is only limited research on multiplayer health games. Evaluation of health games can be both medical and technical, and the focus will depend on the game purpose.
There is still not enough evidence to conclude which design principles work for what purposes since most of the literature in health serious games does not specify design methodologies, but it seems that extrinsic methods work in persuasion. However, when designing health care games it is important to define both the target group and main objective, and then design a game accordingly using sound game design principles, but also utilizing design elements to enhance learning and persuasion. A collaboration with health professionals from an early design stage is necessary both to ensure that the content is valid and to have the game validated from a clinical viewpoint. Patients need to be involved, especially to improve usability. More research should be done on social aspects in health games, both related to learning and persuasion.
Implementation and deployment; Education; Consumer health; Human-computer interaction; Interfaces and usability; Game design; Educational game design; Instructional design; Pedagogy of gaming; Instructional technology
Medical residency programs are likely to face increasing pressure to address their relations with the pharmaceutical industry. Our internal medicine residency program has developed guidelines that were adopted after extensive debate by residents and faculty members. The guidelines are based on the principles that residents and faculty should set the educational agenda and that the residency program should not allow gifts of any sort from industry to residents. Specific policies include obtaining and screening educational materials from the industry before residents are exposed to them, proscribing "drug lunches" and accepting industry sponsorship only when the residency program maintains complete control of the educational event being sponsored. The industry response to the guidelines was split; about half reacted negatively, and half found the guidelines acceptable. Our experience suggests that productive debate about guidelines for the interaction of residency programs with the pharmaceutical industry is possible and desirable and that explicit policies can clarify areas of ambiguity.
The video games industry develops ever more advanced technologies to improve rendering, image quality, ergonomics and user experience of their creations providing very simple to use tools to design new games. In the molecular sciences, only a small number of experts with specialized know-how are able to design interactive visualization applications, typically static computer programs that cannot easily be modified. Are there lessons to be learned from video games? Could their technology help us explore new molecular graphics ideas and render graphics developments accessible to non-specialists? This approach points to an extension of open computer programs, not only providing access to the source code, but also delivering an easily modifiable and extensible scientific research tool. In this work, we will explore these questions using the Unity3D game engine to develop and prototype a biological network and molecular visualization application for subsequent use in research or education. We have compared several routines to represent spheres and links between them, using either built-in Unity3D features or our own implementation. These developments resulted in a stand-alone viewer capable of displaying molecular structures, surfaces, animated electrostatic field lines and biological networks with powerful, artistic and illustrative rendering methods. We consider this work as a proof of principle demonstrating that the functionalities of classical viewers and more advanced novel features could be implemented in substantially less time and with less development effort. Our prototype is easily modifiable and extensible and may serve others as starting point and platform for their developments. A webserver example, standalone versions for MacOS X, Linux and Windows, source code, screen shots, videos and documentation are available at the address: http://unitymol.sourceforge.net/.
Education in emergency ultrasound (EUS) has become an essential part of emergency medicine (EM) resident training. In 2009, comprehensive residency training guidelines were published to ensure proficiency in ultrasound education. The American College of Emergency Physicians (ACEP) recommends that 150 ultrasound exams be performed for physician competency. Our goal is to evaluate the current ultrasound practices among EM residency programs and assess the need for further formalization of EUS training.
We generated a survey using an online survey tool and administered via the internet. The survey consisted of 25 questions that included multiple choice and free text answers. These online survey links were sent via email to EM ultrasound directors at all 149 American College of Graduate Medical Education EM residency programs in April 2008. We surveyed programs regarding EUS curriculum and residency proficiency requirements and descriptive statistics were used to report the survey findings.
Sixty-five residency programs responded to the survey. The average number of ultrasound exams required by programs for EUS competency was 137 scans. However, the majority of programs 42/65 (64%) require their residents to obtain 150 scans or greater for competency. Fifty-one out of 64 (79%) programs reported having a structured ultrasound curriculum while 14/64 (21%) of programs reported that EUS training is primarily resident self-directed. In terms of faculty credentialing, 29/62 (47%) of residency programs have greater than 50% of faculty credentialed. Forty-four out of 61 (72%) programs make EUS a required rotation. Thirty-four out of 63 (54%) programs felt that they were meeting all their goals for resident EUS education.
Currently discrepancies exist between EM residency programs in ultrasound curriculum and perceived needs for achieving proficiency in EUS. Although a majority of residency programs require 150 ultrasound exams or more to achieve resident competency, overall the average number of scans required by all programs is 137 exams. This number is less than that recommended by ACEP for physician competency. These data suggest that guidelines are needed to help standardize ultrasound training for all EM residency programs.
The Accreditation Council for Graduate Medical Education (ACGME) has announced revisions to the resident duty hour standards in light of a 2008 Institute of Medicine report that recommended further limits. Soliciting resident input regarding the future of duty hours is critical to ensure trainee buy-in.
To assess incoming intern perceptions of duty hour restrictions at 3 teaching hospitals.
We administered an anonymous survey to incoming interns during orientation at 3 teaching hospitals affiliated with 2 Midwestern medical schools in 2009. Survey questions assessed interns' perceptions of maximum shift length, days off, ACGME oversight, and preferences for a “fatigued post-call intern who admitted patient” versus “well-rested covering intern who just picked up patient” for various clinical scenarios.
Eighty-six percent (299/346) of interns responded. Although 59% agreed that residents should not work over 16 hours without a break, 50% of interns favored the current limits. The majority (78%) of interns desired ability to exceed shift limit for rare cases or clinical opportunities. Most interns (90%) favored oversight by the ACGME, and 97% preferred a well-rested intern for performing a procedure. Meanwhile, only 48% of interns preferred a well-rested intern for discharging a patient or having an end of life discussion. Interns who favored 16-hour limits were less concerned with negative consequences of duty hour restrictions (handoffs, reduced clinical experience) and more likely to choose the well-rested intern for certain scenarios (odds ratio 2.33, 95% confidence interval 1.42–3.85, P = .001).
Incoming intern perceptions on limiting duty hours vary. Many interns desire flexibility to exceed limits for interesting clinical opportunities and favor ACGME oversight. Clinical context matters when interns consider the tradeoffs between fatigue and discontinuity.
Clinical practice guidelines (CPGs) become quickly outdated and require a periodic reassessment of evidence research to maintain their validity. However, there is little research about this topic. Our project will provide evidence for some of the most pressing questions in this field: 1) what is the average time for recommendations to become out of date?; 2) what is the comparative performance of two restricted search strategies to evaluate the need to update recommendations?; and 3) what is the feasibility of a more regular monitoring and updating strategy compared to usual practice?. In this protocol we will focus on questions one and two.
The CPG Development Programme of the Spanish Ministry of Health developed 14 CPGs between 2008 and 2009. We will stratify guidelines by topic and by publication year, and include one CPG by strata.
We will develop a strategy to assess the validity of CPG recommendations, which includes a baseline survey of clinical experts, an update of the original exhaustive literature searches, the identification of key references (reference that trigger a potential recommendation update), and the assessment of the potential changes in each recommendation.
We will run two alternative search strategies to efficiently identify important new evidence: 1) PLUS search based in McMaster Premium LiteratUre Service (PLUS) database; and 2) a Restrictive Search (ReSe) based on the least number of MeSH terms and free text words needed to locate all the references of each original recommendation.
We will perform a survival analysis of recommendations using the Kaplan-Meier method and we will use the log-rank test to analyse differences between survival curves according to the topic, the purpose, the strength of recommendations and the turnover. We will retrieve key references from the exhaustive search and evaluate their presence in the PLUS and ReSe search results.
Our project, using a highly structured and transparent methodology, will provide guidance of when recommendations are likely to be at risk of being out of date. We will also assess two novel restrictive search strategies which could reduce the workload without compromising rigour when CPGs developers check for the need of updating.
Clinical practice guidelines; Diffusion of innovation; Dissemination and implementation; Evidence-based medicine; Information storage and retrieval; Knowledge translation; Methodology; Updating
While the Accreditation Council for Graduate Medical Education recommends multisource feedback (MSF) of resident performance, there is no uniformly accepted MSF tool for emergency medicine (EM) trainees, and the process of obtaining MSF in EM residencies is untested.
To determine the feasibility of an MSF program and evaluate the intraclass and interclass correlation of a previously reported resident professionalism evaluation, the Humanism Scale (HS).
To assess 10 third-year EM residents, we distributed an anonymous 9-item modified HS (EM-HS) to emergency department nursing staff, faculty physicians, and patients. The evaluators rated resident performance on a 1 to 9 scale (needs improvement to outstanding). Residents were asked to complete a self-evaluation of performance, using the same scale.
Generalizability coefficients (Eρ2) were used to assess the reliability within evaluator classes. The mean score for each of the 9 questions provided by each evaluator class was calculated for each resident. Correlation coefficients were used to evaluate correlation between rater classes for each question on the EM-HS. Eρ2 and correlation values greater than 0.70 were deemed acceptable.
EM-HSs were obtained from 44 nurses and 12 faculty physicians. The residents had an average of 13 evaluations by emergency department patients. Reliability within faculty and nurses was acceptable, with Eρ2 of 0.79 and 0.83, respectively. Interclass reliability was good between faculty and nurses.
An MSF program for EM residents is feasible. Intraclass reliability was acceptable for faculty and nurses. However, reliable feedback from patients requires a larger number of patient evaluations.
This article aims to introduce the nature of data integration to life scientists. Generally, the subject of data integration is not discussed outside the field of computational science and is not covered in any detail, or even neglected, when teaching/training trainees. End users (hereby defined as wet-lab trainees, clinicians, lab researchers) will mostly interact with bioinformatics resources and tools through web interfaces that mask the user from the data integration processes. However, the lack of formal training or acquaintance with even simple database concepts and terminology often results in a real obstacle to the full comprehension of the resources and tools the end users wish to access. Understanding how data integration works is fundamental to empowering trainees to see the limitations as well as the possibilities when exploring, retrieving, and analysing biological data from databases. Here we introduce a game-based learning activity for training/teaching the topic of data integration that trainers/educators can adopt and adapt for their classroom. In particular we provide an example using DAS (Distributed Annotation Systems) as a method for data integration.
Obesity and diabetes have reached epidemic proportions in both developing and developed nations. While doctors and caregivers stress the importance of physical exercise in maintaining a healthy lifestyle, many people have difficulty subscribing to a healthy lifestyle. Virtual reality games offer a potentially exciting aid in accelerating and sustaining behavior change. However, care needs to be taken to develop sustainable models of employing games for the management of diabetes and obesity. In this article, we propose an integrative gaming paradigm designed to combine multiple activities involving physical exercises and cognitive skills through a game-based storyline. The persuasive story acts as a motivational binder that enables a user to perform multiple activities such as running, cycling, and problem solving. These activities guide a virtual character through different stages of the game. While performing the activities in the games, users wear sensors that can measure movement (accelerometers, gyrometers, magnetometers) and sense physiological measures (heart rate, pulse oximeter oxygen saturation). These measures drive the game and are stored and analyzed on a cloud computing platform. A prototype integrative gaming system is described and design considerations are discussed. The system is highly configurable and allows researchers to build games for the system with ease and drive the games with different types of activities. The capabilities of the system allow for engaging and motivating the user in the long term. Clinicians can employ the system to collect clinically relevant data in a seamless manner.
compliance; education; game design for diabetes; integrative gaming
Understanding infant feeding practices in the context of HIV and factors that put mothers at risk of HIV infection is an important step towards prevention of mother to child transmission of HIV (PMTCT). Face-to-face (FTF) interviewing may not be a suitable way of ascertaining this information because respondents may report what is socially desirable. Audio computer-assisted self-interviewing (ACASI) is thought to increase privacy, reporting of sensitive issues and to eliminate socially desirable responses. We compared ACASI with FTF interviewing and explored its feasibility, usability, and acceptability in a PMTCT program in Kenya.
A graphic user interface (GUI) was developed using Macromedia Authorware® and questions and instructions recorded in local languages Kikuyu and Kiswahili. Eighty mothers enrolled in the PMTCT program were interviewed with each of the interviewing mode (ACASI and FTF) and responses obtained in FTF interviews and ACASI compared using McNemar's χ2 for paired proportions. A paired Student's t-test was used to compare means of age, marital-time and parity when measuring interview mode effect and two-sample Student's t-test to compare means for samples stratified by education level – determined during the exit interview. A Chi-Square (χ2test) was used to compare ability to use ACASI by education level.
Mean ages for intended time for breastfeeding as reported by ACASI were 11 months by ACASI and 19 months by FTF interviewing (p < 0.001). Introduction of complementary foods at ≤3 months was reported more frequently by respondents in ACASI compared to FTF interviews for 7 of 13 complementary food items commonly utilized in the study area (p < 0.05). More respondents reported use of unsuitable utensils for infant feeding in ACASI than in FTF interviewing (p = 0.001). In other sensitive questions, 7% more respondents reported unstable relationships with ACASI than when interviewed FTF (p = 0.039). Regardless of education level, respondents used ACASI similarly and majority (65%) preferred it to FTF interviewing mainly due to enhanced usability and privacy. Most respondents (79%) preferred ACASI to FTF for future interviewing.
ACASI seems to improve quality of information by increasing response to sensitive questions, decreasing socially desirable responses, and by preventing null responses and was suitable for collecting data in a setting where formal education is low.
Although systematic use of the Perinatal Society of Australia and New Zealand internationally endorsed Clinical Practice Guideline for Perinatal Mortality (PSANZ-CPG) improves health outcomes, implementation is inadequate. Its complexity is a feature known to be associated with non-compliance. Interactive education is effective as a guideline implementation strategy, but lacks an agreed definition. SCORPIO is an educational framework containing interactive and didactic teaching, but has not previously been used to implement guidelines. Our aim was to transform the PSANZ-CPG into an education workshop to develop quality standardised interactive education acceptable to participants for learning skills in collaborative interprofessional care.
The workshop was developed using the construct of an educational framework (SCORPIO), the PSANZ-CPG, a transformation process and tutor training. After a pilot workshop with key target and stakeholder groups, modifications were made to this and subsequent workshops based on multisource written observations from interprofessional participants, tutors and an independent educator. This participatory action research process was used to monitor acceptability and educational standards. Standardised interactive education was defined as the attainment of content and teaching standards. Quantitative analysis of positive expressed as a percentage of total feedback was used to derive a total quality score.
Eight workshops were held with 181 participants and 15 different tutors. Five versions resulted from the action research methodology. Thematic analysis of multisource observations identified eight recurring education themes or quality domains used for standardisation. The two content domains were curriculum and alignment with the guideline and the six teaching domains; overload, timing, didacticism, relevance, reproducibility and participant engagement. Engagement was the most challenging theme to resolve. Tutors identified all themes for revision whilst participants identified a number of teaching but no content themes. From version 1 to 5, a significant increasing trend in total quality score was obtained; participants: 55%, p=0.0001; educator: 42%, p=0.0004; tutor peers: 57%, p=0.0001.
Complex clinical guidelines can be developed into a workshop acceptable to interprofessional participants. Eight quality domains provide a framework to standardise interactive teaching for complex clinical guidelines. Tutor peer review is important for content validity. This methodology may be useful for other guideline implementation.
Practice guidelines as a topic; Implementation; Information dissemination; Education medical continuing; Interprofessional education; Action research; Perinatal mortality; Stillbirth; Fetal death
Translational research using evidence-based and comparative effectiveness research continues to evolve, becoming a useful tool in improving informed
consent and decision-making in the clinical setting. While in development, emerging technologies, including cellular and molecular biology, are leading to
establishing evidence-based dental practices. One emerging technology, which conjoins bench proteomic findings to clinical decision-making for
treatment intervention, is the Translational Evidence Mechanism. This mechanism was developed to be a foundation for a compact between researcher,
translational researcher, clinician, and patient. The output of such a mechanism is the clinical practice guideline (CPG), an interactive tool for dentists and
patients to game evidence in reaching optimum clinical decisions that correspond to individual patient preferences and values. As such, the clinical
practice guideline requires the vesting of decision, utility, and cost best evidence. Evidence-based research provides decision data, a first attempt at
supporting decision-making by providing best outcome data. Since then comparative effectiveness research has emerged, using systematic review analysis
to compare similar treatments or procedures in maximizing the choice of the most effective cost/benefit option within the context of best evidence. With
innovation in the clinical practice guideline for optimizing efficacy and comparative effectiveness research, evidence-based practices will shape a new
approach to health-based systems that adhere to shared decision-making between bench scientists, healthcare providers and patients.
Translational evidence; clinical decision-making; clinical practice guidelines (CPG's); evidence-based practice; comparative efficacy; effectiveness research