Context Although technology-enhanced simulation has widespread appeal, its effectiveness remains uncertain. A comprehensive synthesis of evidence may inform the use of simulation in health professions education. Objective To summarize the outcomes of technology-enhanced simulation training for health professions learners in comparison with no intervention. Data Source Systematic search of MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, Scopus, key journals, and previous review bibliographies through May 2011. Study Selection Original research in any language evaluating simulation compared with no intervention for training practicing and student physicians, nurses, dentists, and other health care professionals. Data Extraction Reviewers working in duplicate evaluated quality and abstracted information on learners, instructional design (curricular integration, distributing training over multiple days, feedback, mastery learning, and repetitive practice), and outcomes. We coded skills (performance in a test setting) separately for time, process, and product measures, and similarly classified patient care behaviors. Data Synthesis From a pool of 10 903 articles, we identified 609 eligible studies enrolling 35 226 trainees. Of these, 137 were randomized studies, 67 were nonrandomized studies with 2 or more groups, and 405 used a single-group pretest-posttest design. We pooled effect sizes using random effects. Heterogeneity was large (I2>50%) in all main analyses. In comparison with no intervention, pooled effect sizes were 1.20 (95% CI, 1.04-1.35) for knowledge outcomes (n = 118 studies), 1.14 (95% CI, 1.03-1.25) for time skills (n = 210), 1.09 (95% CI, 1.03-1.16) for process skills (n = 426), 1.18 (95% CI, 0.98-1.37) for product skills (n = 54), 0.79 (95% CI, 0.47-1.10) for time behaviors (n = 20), 0.81 (95% CI, 0.66-0.96) for other behaviors (n = 50), and 0.50 (95% CI, 0.34-0.66) for direct effects on patients (n = 32). Subgroup analyses revealed no consistent statistically significant interactions between simulation training and instructional design features or study quality. Conclusion In comparison with no intervention, technology-enhanced simulation training in health professions education is consistently associated with large effects for outcomes of knowledge, skills, and behaviors and moderate effects for patient-related outcomes.

https://jamanetwork.com/journals/jama/articlepdf/1104300/jrv15009_978_988.pdf

Technology-enhanced simulation for health professions education: a systematic review and meta-analysis

Practice is a necessary but not sufficient condition to reach high levels of competence. Deliberate practice, which includes five basic elements, is needed to build expertise. Those elements include: 1. Effortful exertion to improve performance 2. Intrinsic motivation to engage in the task 3. Carefully tailored practice tasks that focus on areas of weakness 4. Feedback that provides knowledge of results, and 5. Continued repetition over a number of years (p. 256)

e‐Learning and the Science of Instruction

The use of animation and multimedia for learning is now further extended by the provision of entire Virtual Reality Learning Environments (VRLE). This highlights a shift in Web-based learning from a conventional multimedia to a more immersive, interactive, intuitive and exciting VR learning environment. VRLEs simulate the real world through the application of 3D models that initiates interaction, immersion and trigger the imagination of the learner. The question of good pedagogy and use of technology innovations comes into focus once again. Educators attempt to find theoretical guidelines or instructional principles that could assist them in developing and applying a novel VR learning environment intelligently. This paper introduces the educational use of Web-based 3D technologies and highlights in particular VR features. It then identifies constructivist learning as the pedagogical engine driving the construction of VRLE and discusses five constructivist learning approaches. Furthermore, the authors provide two case studies to investigate VRLEs for learning purposes. The authors conclude with formulating some guidelines for the effective use of VRLEs, including discussion of the limitations and implications for the future study of VRLEs.

Investigating learners' attitudes toward virtual reality learning environments: Based on a constructivist approach

Online learning as a concept and as a keyword has consistently been a focus of education research for over two decades. In this paper, we present results from a systematic literature review for the...

How Many Ways Can We Define Online Learning? A Systematic Literature Review of Definitions of Online Learning (1988-2018).

PurposeThe authors conducted a systematic review of the published literature on social media use in medical education to answer two questions: (1) How have interventions using social media tools affected outcomes of satisfaction, knowledge, attitudes, and skills for physicians and physicians-in-trai

Social media use in medical education: a systematic review.

279%) in all analyses. Effect sizes were pooled using a random effects model. The pooled effect size in comparison to no intervention favored Internet-based interventions and was 1.00 (95% confidence interval [CI], 0.90-1.10; P .001; n=126 studies) for knowledge outcomes, 0.85 (95% CI, 0.49-1.20; P .001; n=16) for skills, and 0.82 (95% CI, 0.63-1.02; P .001; n=32) for learner behaviors and patient effects. Compared with non-Internet formats, the pooled effect sizes (positive numbers favoring Internet) were 0.10 (95% CI, �0.12 to 0.32; P=.37; n=43) for satisfaction, 0.12 (95% CI, 0.003 to 0.24; P=.045; n=63) for knowledge, 0.09 (95% CI, �0.26 to 0.44; P=.61; n=12) for skills, and 0.51 (95% CI, �0.24 to 1.25; P=.18; n=6) for behaviors or patient effects. No important treatment-subgroup interactions were identified. Conclusions Internet-based learning is associated with large positive effects compared with no intervention. In contrast, effects compared with non-Internet instructional methods are heterogeneous and generally small, suggesting effectiveness similar to traditional methods. Future research should directly compare different Internet-based interventions.

Internet-Based Learning in the Health Professions

Objective Mitochondrial disorders are caused by gene mutations in mitochondrial or nuclear DNA and affect energy-dependent organs such as the brain. Patients with psychiatric illness, particularly those with medical comorbidities, may have primary mitochondrial disorders. To date, this issue has received little attention in the literature, and mitochondrial disorders are likely underdiagnosed in psychiatric patients. Data sources This article describes a patient who presented with borderline personality disorder and treatment-resistant depression and was ultimately diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) 3271. We also searched the literature for all case reports of patients with mitochondrial disorders who initially present with prominent psychiatric symptoms by using MEDLINE (from 1948-February 2011), Embase (from 1980-February 2011), PsycINFO (from 1806-February 2011), and the search terms mitochondrial disorder, mitochondria, psychiatry, mental disorders, major depression, anxiety, schizophrenia, and psychosis. Study selection Fifty cases of mitochondrial disorders with prominent psychiatric symptomatology were identified. Data extraction Information about the psychiatric presentation of the cases was extracted. This information was combined with our case, the most common psychiatric manifestations of mitochondrial disorders were identified, and the important diagnostic and treatment implications for patients with psychiatric illness were reviewed. Results The most common psychiatric presentations in the cases of mitochondrial disorders included mood disorder, cognitive deterioration, psychosis, and anxiety. The most common diagnosis (52% of cases) was a MELAS mutation. Other genetic mitochondrial diagnoses included polymerase gamma mutations, Kearns-Sayre syndrome, mitochondrial DNA deletions, point mutations, twinkle mutations, and novel mutations. Conclusions Patients with mitochondrial disorders can present with primary psychiatric symptomatology, including mood disorder, cognitive impairment, psychosis, and anxiety. Psychiatrists need to be aware of the clinical features that are indicative of a mitochondrial disorder, investigate patients with suggestive presentations, and be knowledgeable about the treatment implications of the diagnosis.

The psychiatric manifestations of mitochondrial disorders: a case and review of the literature.

Medical Education 2011: 45: 227–238



Context  Studies evaluating reporting quality in health professions education (HPE) research have demonstrated deficiencies, but none have used comprehensive reporting standards. Additionally, the relationship between study methods and effect size (ES) in HPE research is unknown.



Objectives  This review aimed to evaluate, in a sample of experimental studies of Internet-based instruction, the quality of reporting, the relationship between reporting and methodological quality, and associations between ES and study methods.



Methods  We conducted a systematic search of databases including MEDLINE, Scopus, CINAHL, EMBASE and ERIC, for articles published during 1990–2008. Studies (in any language) quantifying the effect of Internet-based instruction in HPE compared with no intervention or other instruction were included. Working independently and in duplicate, we coded reporting quality using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement, and coded study methods using a modified Newcastle–Ottawa Scale (m-NOS), the Medical Education Research Study Quality Instrument (MERSQI), and the Best Evidence in Medical Education (BEME) global scale.



Results  For reporting quality, articles scored a mean ± standard deviation (SD) of 51 ± 25% of STROBE elements for the Introduction, 58 ± 20% for the Methods, 50 ± 18% for the Results and 41 ± 26% for the Discussion sections. We found positive associations (all p < 0.0001) between reporting quality and MERSQI (ρ = 0.64), m-NOS (ρ = 0.57) and BEME (ρ = 0.58) scores. We explored associations between study methods and knowledge ES by subtracting each study’s ES from the pooled ES for studies using that method and comparing these differences between subgroups. Effect sizes in single-group pretest/post-test studies differed from the pooled estimate more than ESs in two-group studies (p = 0.013). No difference was found between other study methods (yes/no: representative sample, comparison group from same community, randomised, allocation concealed, participants blinded, assessor blinded, objective assessment, high follow-up).



Conclusions  Information is missing from all sections of reports of HPE experiments. Single-group pre-/post-test studies may overestimate ES compared with two-group designs. Other methodological variations did not bias study results in this sample.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2923.2010.03890.x

Method and reporting quality in health professions education research: a systematic review

Adrenoleukodystrophy is an inherited X-linked peroxisomal disorder that preferentially affects the adrenal cortex, testes, and brain and may occur at almost any age. Psychiatric symptomatology is present in many of the adult-onset cases reported in the literature and may be one of the earliest manifestations of the disease. The majority of patients with psychiatric disturbances have signs and symptoms typical of mania. Psychosis and cognitive impairment may also be prominent. Metabolic diseases such as adrenoleukodystrophy are probably underrecognized as a cause of psychiatric illness. Increased awareness of these disorders will lead to accurate diagnosis, appropriate treatment selection, and genetic counseling.

https://neuro.psychiatryonline.org/doi/pdfplus/10.1176/jnp.11.3.315

Sarah Garside

Papers

Internet-Based Learning in the Health Professions

The psychiatric manifestations of mitochondrial disorders: a case and review of the literature.

Method and reporting quality in health professions education research: a systematic review

The neuropsychiatry of adult-onset adrenoleukodystrophy.

Dopamine–glutamate interactions in the striatum: behaviourally relevant modification of excitotoxicity by dopamine receptor-mediated mechanisms