Virtual training for small group facilitators.

BACKGROUND: In addition to providing patient care, interprofessional health care teams work collaboratively on a variety of projects. These projects often benefit from using facilitated small group project discussion sessions, such as the Harvard Macy Institute's (HMI) Step Back Process (SBP). Although having a trained facilitator is an important component of the SBP, only a limited number of health care professionals can attend HMI courses in person or virtually, limiting its impact. APPROACH: We developed three video-based education (VBE) modules to deliver facilitator training on the SBP, informed by principles of Mayer's cognitive theory of multimedia learning. For module development, we used a five-step approach. We evaluated effectiveness of the modules as a self-directed method to enhance SBP facilitator training. An initial survey collected demographic data and module feedback, a follow-up survey collected feedback on the modules' impact on facilitation and interviews focused on the participants' overall experience. EVALUATION: Survey results indicated that the modules were positively received and helped to improve participant confidence in facilitating. We identified four themes from the interviews: challenges of facilitating, value of group feedback, value of modules for experienced facilitators and the modules as part of a multi-modal approach to train new facilitators. IMPLICATIONS: This innovation provides insight on delivering facilitator training on the SBP using VBE. Health professions educators developing online facilitator training could adapt our development process and modify implementation guided by our results. Future work should evaluate the best methods to integrate VBE modules into a longitudinal virtual community and assess facilitation techniques.

Development and Utilization of a Medical Student Surgery Podcast During COVID-19.

BACKGROUND: The 2019 coronavirus disease (COVID-19) pandemic drastically reduced learning opportunities for medical students. We sought to determine the cost and success of implementation of a podcast for a surgical department in a large academic hospital. METHODS: We created a podcast series for Israeli medical students during the COVID-19 epidemic based on the Medical Student Core Curriculum of the American College of Surgeons / Association for Surgical Education. Episodes were available for free download or streaming on a designated website and popular podcast platforms. Podcast analytics were used to measure public listeners and uptake. RESULTS: Total development time was 90 hours at an estimated cost of $7091 USD. A total of 10 episodes were released between March 21, 2020 and August 31, 2020. An average of 9 ± 1.26 h (range 2-6) was required to generate each episode, including 3.4 ± 1.26 h (2-6) for content review and 5.6 ± 2 h (4-10) for audio production. An average episode ran for 35.9 ± 4.3 min (28-42). Podcasts recorded a total of 5678 downloads, with an average of 228 and 336 downloads per episode in the first 30 and 90 days, respectively. The average daily downloads before the students returned to clinical rotations (March 21-April 30) was 48 ± 58.3 (7-283;) compared to 16 ± 7.4 after their return (1-38; P< 0.01). Estimated costs to produce a video-based education series would have been significantly more. CONCLUSION: Podcasts can serve as a cost-effective and quickly produced instructional tool to supplement online learning. Further research is required to determine the efficacy of podcasts versus video-based education modules.

Applying a novel cost-evaluation framework to assess video-based neurosurgery education.

BACKGROUND: Analysis of comparative effectiveness uses different metrics to ensure that a new treatment is both effective and economical. However, there is a lack of financial frameworks to estimate the costs of introducing new technologies in medical and surgical education. METHODS: After conducting a literature review, we created and applied a framework ('REC') for the evaluation of three recent neurosurgery video modules aimed at medical students at Harvard Medical School. RESULTS: The most expensive component of these video-based education (VBE) modules was time cost. This cost was highly variable depending on the level of clinical seniority of the individuals involved in the video production process. CONCLUSION: Application of the REC framework to the three modules showed highly variable time and monetary cost differences between the modules. Usage of the REC framework will enable educators to institute effective planning, efficiently use resources, and clearly define a minimal viable education product to achieve desired learning outcomes.

NEJM Knowledge+ Question of the Week: A Novel Virtual Learning Community Effectively Utilizing an Online Discussion Forum.

Objectives: Asynchronous virtual learning communities provide learners with the ability to enhance their learning and contribute to their peers' learning in a safe environment. However, the tone and content of learner comments, the level of engagement among learners, and the role of moderators have not been well studied within non-course-related virtual learning communities. Therefore, we sought to explore these characteristics using the NEJM Knowledge+ Question of the Week (NEJM Knowledge+ QoW) forum, a web-based asynchronous virtual learning community. Methods: We reviewed 73 NEJM Knowledge+ questions posted on the QoW forum between 2015 and 2016. We then selected three QoWs to analyze through a multistep coding process based on three broad criteria that aligned with our study aims. Results: Learner comments reflected both positive and critical tones, with learners sharing their own clinical practice and local experiences to contextualize their perspectives and reactions to both the QoW answer and the responses of other learners. Learners also commonly requested moderators to act as expert referees. Conclusion: Asynchronous virtual learning communities can engage learners by providing the opportunity to enhance their knowledge through responding to proposed medical scenarios and sharing their experiences in a discussion forum. Future work should examine the impact that geographic region has on asynchronous virtual learning communities and the role of moderators in shaping the learning experience.

High survivin levels predict poor clinical response to infliximab treatment in patients with rheumatoid arthritis.

OBJECTIVE: To evaluate if the measurement of survivin in the blood of patients with rheumatoid arthritis (RA) undergoing infliximab treatment has predictive value for treatment response. METHODS: The study included 87 consecutive RA patients (age 24-89 years, disease duration 18-526 months) treated with regular infusions of influximab. Survivin levels were measured by enzyme-linked immunosorbent assay and evaluated in relation to the total dose of infliximab, disease activity (DAS28), response to infliximab treatment (change in DAS28 >1.2), and radiographic damage (vdH-Sharp score). RESULTS: Thirty-seven percent of patients were survivin-positive (survivin >0.9 ng/mL) and showed severe radiographic damage at the start of infliximab treatment compared with survivin-negative (P = 0.027). Patients with high survivin levels were unlikely to respond to infliximab treatment (OR 4.02 [1.22-14.61], P = 0.022) and achieve remission (OR 4.32[1.01-30.11], P = 0.048) compared with patients with low survivin levels. CONCLUSIONS: High survivin levels are associated with severe radiographic damage at the start of treatment and a poor response to infliximab. Survivin measurement should be considered an additional tool for aiding the selection and follow-up of antirheumatic treatment.