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      Design and Implementation of a Novel Web-Based E-Learning Tool for Education of Health Professionals on the Antibiotic Vancomycin

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          Abstract

          Background

          Traditional approaches to health professional education are being challenged by increased clinical demands and decreased available time. Web-based e-learning tools offer a convenient and effective method of delivering education, particularly across multiple health care facilities. The effectiveness of this model for health professional education needs to be explored in context.

          Objectives

          The study aimed to (1) determine health professionals’ experience and knowledge of clinical use of vancomycin, an antibiotic used for treatment of serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and (2) describe the design and implementation of a Web-based e-learning tool created to improve knowledge in this area.

          Methods

          We conducted a study on the design and implementation of a video-enhanced, Web-based e-learning tool between April 2014 and January 2016. A Web-based survey was developed to determine prior experience and knowledge of vancomycin use among nurses, doctors, and pharmacists. The Vancomycin Interactive (VI) involved a series of video clips interspersed with question and answer scenarios, where a correct response allowed for progression. Dramatic tension and humor were used as tools to engage users. Health professionals’ knowledge of clinical vancomycin use was obtained from website data; qualitative participant feedback was also collected.

          Results

          From the 577 knowledge survey responses, pharmacists (n=70) answered the greatest number of questions correctly (median score 4/5), followed by doctors (n=271; 3/5) and nurses (n=236; 2/5; P<.001). Survey questions on target trough concentration (75.0%, 433/577) and rate of administration (64.9%, 375/577) were answered most correctly, followed by timing of first level (49%, 283/577), maintenance dose (41.9%, 242/577), and loading dose (38.0%, 219/577). Self-reported “very” and “reasonably” experienced health professionals were also more likely to achieve correct responses. The VI was completed by 163 participants during the study period. The rate of correctly answered VI questions on first attempt was 65% for nurses (n=63), 68% for doctors (n=86), and 82% for pharmacists (n=14; P<.001), reflecting a similar pattern to the knowledge survey. Knowledge gaps were identified for loading dose (39.2% correct on first attempt; 64/163), timing of first trough level (50.3%, 82/163), and subsequent trough levels (47.9%, 78/163). Of the 163 participants, we received qualitative user feedback from 51 participants following completion of the VI. Feedback was predominantly positive with themes of “entertaining,” “engaging,” and “fun” identified; however, there were some technical issues identified relating to accessibility from different operating systems and browsers.

          Conclusions

          A novel Web-based e-learning tool was successfully developed combining game design principles and humor to improve user engagement. Knowledge gaps were identified that allowed for targeting of future education strategies. The VI provides an innovative model for delivering Web-based education to busy health professionals in different locations.

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          Most cited references31

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          A Systematic Review of Serious Games in Training Health Care Professionals.

          Serious games are computer-based games designed for training purposes. They are poised to expand their role in medical education. This systematic review, conducted in accordance with PRISMA guidelines, aimed to synthesize current serious gaming trends in health care training, especially those pertaining to developmental methodologies and game evaluation. PubMed, EMBASE, and Cochrane databases were queried for relevant documents published through December 2014. Of the 3737 publications identified, 48 of them, covering 42 serious games, were included. From 2007 to 2014, they demonstrate a growth from 2 games and 2 genres to 42 games and 8 genres. Overall, study design was heterogeneous and methodological quality by MERQSI score averaged 10.5/18, which is modest. Seventy-nine percent of serious games were evaluated for training outcomes. As the number of serious games for health care training continues to grow, having schemas that organize how educators approach their development and evaluation is essential for their success.
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            Time and learning efficiency in Internet-based learning: a systematic review and meta-analysis.

            Authors have claimed that Internet-based instruction promotes greater learning efficiency than non-computer methods. determine, through a systematic synthesis of evidence in health professions education, how Internet-based instruction compares with non-computer instruction in time spent learning, and what features of Internet-based instruction are associated with improved learning efficiency. we searched databases including MEDLINE, CINAHL, EMBASE, and ERIC from 1990 through November 2008. STUDY SELECTION AND DATA ABSTRACTION we included all studies quantifying learning time for Internet-based instruction for health professionals, compared with other instruction. Reviewers worked independently, in duplicate, to abstract information on interventions, outcomes, and study design. we identified 20 eligible studies. Random effects meta-analysis of 8 studies comparing Internet-based with non-Internet instruction (positive numbers indicating Internet longer) revealed pooled effect size (ES) for time -0.10 (p = 0.63). Among comparisons of two Internet-based interventions, providing feedback adds time (ES 0.67, p =0.003, two studies), and greater interactivity generally takes longer (ES 0.25, p = 0.089, five studies). One study demonstrated that adapting to learner prior knowledge saves time without significantly affecting knowledge scores. Other studies revealed that audio narration, video clips, interactive models, and animations increase learning time but also facilitate higher knowledge and/or satisfaction. Across all studies, time correlated positively with knowledge outcomes (r = 0.53, p = 0.021). on average, Internet-based instruction and non-computer instruction require similar time. Instructional strategies to enhance feedback and interactivity typically prolong learning time, but in many cases also enhance learning outcomes. Isolated examples suggest potential for improving efficiency in Internet-based instruction.
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              Design, development, and evaluation of an online virtual emergency department for training trauma teams.

              Training interdisciplinary trauma teams to work effectively together using simulation technology has led to a reduction in medical errors in emergency department, operating room, and delivery room contexts. High-fidelity patient simulators (PSs)-the predominant method for training healthcare teams-are expensive to develop and implement and require that trainees be present in the same place at the same time. In contrast, online computer-based simulators are more cost effective and allow simultaneous participation by students in different locations and time zones. In this pilot study, the researchers created an online virtual emergency department (Virtual ED) for team training in crisis management, and compared the effectiveness of the Virtual ED with the PS. We hypothesized that there would be no difference in learning outcomes for graduating medical students trained with each method. In this pilot study, we used a pretest-posttest control group, experimental design in which 30 subjects were randomly assigned to either the Virtual ED or the PS system. In the Virtual ED each subject logged into the online environment and took the role of a team member. Four-person teams worked together in the Virtual ED, communicating in real time with live voice over Internet protocol, to manage computer-controlled patients who exhibited signs and symptoms of physical trauma. Each subject had the opportunity to be the team leader. The subjects' leadership behavior as demonstrated in both a pretest case and a posttest case was assessed by 3 raters, using a behaviorally anchored scale. In the PS environment, 4-person teams followed the same research protocol, using the same clinical scenarios in a Simulation Center. Guided by the Emergency Medicine Crisis Resource Management curriculum, both the Virtual ED and the PS groups applied the basic principles of team leadership and trauma management (Advanced Trauma Life Support) to manage 6 trauma cases-a pretest case, 4 training cases, and a posttest case. The subjects in each group were assessed individually with the same simulation method that they used for the training cases. Subjects who used either the Virtual ED or the PS showed significant improvement in performance between pretest and posttest cases (P < 0.05). In addition, there was no significant difference in subjects' performance between the 2 types of simulation, suggesting that the online Virtual ED may be as effective for learning team skills as the PS, the method widely used in Simulation Centers. Data on usability and attitudes toward both simulation methods as learning tools were equally positive. This study shows the potential value of using virtual learning environments for developing medical students' and resident physicians' team leadership and crisis management skills.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J. Med. Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications (Toronto, Canada )
                1439-4456
                1438-8871
                March 2017
                30 March 2017
                : 19
                : 3
                : e93
                Affiliations
                [01] 1Wollongong Hospital Department of Pharmacy Illawarra Shoalhaven Local Health District WollongongAustralia
                [02] 2School of Medicine Faculty of Science, Medicine and Health University of Wollongong WollongongAustralia
                [03] 3Illawarra Health and Medical Research Institute University of Wollongong WollongongAustralia
                [04] 4St George Hospital Department of Pharmacy South Eastern Sydney Local Health District KogarahAustralia
                [05] 5St George Clinical School Faculty of Medicine University of New South Wales KogarahAustralia
                [06] 6Prince of Wales Hospital Department of Pharmacy South Eastern Sydney Local Health District RandwickAustralia
                [07] 7School of Computing and Information Technology Faculty of Engineering and Information Sciences University of Wollongong WollongongAustralia
                [08] 8Research Central Wollongong Hospital Illawarra Shoalhaven Local Health District WollongongAustralia
                [09] 9Wollongong Hospital Department of Infectious Diseases Illawarra Shoalhaven Local Health District WollongongAustralia
                [10] 10Wollongong Hospital Division of Medicine Illawarra Shoalhaven Local Health District WollongongAustralia
                Author notes
                Corresponding Author: Stuart Evan Bond stuart.bond@ 123456health.nsw.gov.au
                Author information
                http://orcid.org/0000-0001-9640-2474
                http://orcid.org/0000-0003-4259-3484
                http://orcid.org/0000-0001-5454-4300
                http://orcid.org/0000-0002-4905-1269
                http://orcid.org/0000-0002-7910-9396
                http://orcid.org/0000-0003-3651-898X
                http://orcid.org/0000-0002-4754-0501
                http://orcid.org/0000-0001-9554-5203
                http://orcid.org/0000-0003-4268-1599
                Article
                v19i3e93
                10.2196/jmir.6971
                5391435
                28360025
                1800735e-f4d8-4f21-ba91-ee10d38f6046
                ©Stuart Evan Bond, Shelley P Crowther, Suman Adhikari, Adriana J Chubaty, Ping Yu, Jay P Borchard, Craig Steven Boutlis, Wilfred Winston Yeo, Spiros Miyakis. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 30.03.2017.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 13 November 2016
                : 5 January 2017
                : 2 February 2017
                : 22 February 2017
                Categories
                Original Paper
                Original Paper

                Medicine
                nursing education,pharmacy education,medical education,continuing education,vancomycin,survey methods,anti-bacterial agents

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