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Introduction: Effective intra- and interprofessional collaboration abilities are necessary for safe and effective medical care, however such roles are often informally taught in postgraduate medical education, with lack of opportunity for practice and feedback. The objective structured clinical examination (OSCE) is a common approach in medical education. Adaptations of the OSCE have been found useful in the assessment of collaborator competencies amongst interprofessional student groups and in the assessment of intrinsic roles, such as collaboration. Objective: The purpose of this study was to evaluate the effectiveness of a collaborator objective structured clinical examination (COSCE) as a method of formative assessment of collaborator competencies for postgraduate trainees. Methods: This study involved a one-group pretest-posttest evaluation conducted in 2018. Postgraduate year-1 (PGY1) residents completed a team skills scale immediately before and after COSCE participation and an evaluation survey to report satisfaction, and were assessed by facilitators and peer assessors using a COSCE rubric. Results: Residents reported significant improvement in their pre (n = 35) to post (n = 37) team skills scores and an overall positive level of satisfaction with the COSCE experience (n = 37/39, 94.9% response rate). The lowest performance scores across all COSCE stations were transfer of care skills (e.g., handover). Peer assessor (n = 204) and facilitator (n = 47) scores indicated a moderate level of interrelatedness. Conclusion: A COSCE is a feasible method of formative assessment, fostering role understanding of other health professions and providing feedback on collaborator skills early in postgraduate medical education. Peer assessment may also hold promise as a formative assessment method for intra- and interprofessional collaboration. [ABSTRACT FROM AUTHOR]

Introduction: International medical graduates (IMGs) play an important role in physician resource planning in many countries and are heavily relied on to fill vacancies in underserved communities. New IMGs may experience difficulty with understanding how medicine is organized in new countries. Effective orientation processes can assist new IMGs in making successful transitions to medical practice in their new countries, reducing professional isolation and enhancing the integration of IMGs and their families within their new communities. The purpose of this qualitative study was to explore perceptions of, and experiences with, orientation processes for new IMGs. Methods: A stratified sample of IMGs and senior administrators of medical services from each of the regional health authorities in Newfoundland and Labrador was invited to participate in semistructured telephone interviews. Results: Thirteen general practitioners/family physicians, 6 specialists and 4 administrators were interviewed. New IMGs need to learn about the health care system and the peculiarities of the specific practice context in which they will be working. Orientation needs to include opportunities for reflecting on one's own cultural biases and for learning about the cultural background and beliefs of a new patient population. Mentoring and effective integration within the community also emerged as important components of effective orientation processes. Discussion: Our findings suggest that orientation processes for new IMGs must be attentive to both professional and personal needs, comprehensive, multifaceted and sustained. Orientation that is responsive to the various needs of new IMGs and their families may contribute to enhanced retention. Conclusion: Effective orientation processes are an important means of reducing professional isolation and supporting new IMGs in the transition to medical practice in their new communities. [ABSTRACT FROM AUTHOR]

The benefits of interprofessional care in providing mental health services have been recognized, particularly in rural communities where health services are limited. In addition, there is a need for more continuing professional education in mental health intervention in rural areas. Although interprofessional collaboration and continuing education have both been proposed to address the paucity of mental health services available in rural areas, there have been no programs developed in which the two components have been combined. This paper describes the development, implementation, and evaluation of an interprofessional continuing education program specifically designed to enhance rural mental health capacity. [ABSTRACT FROM AUTHOR]

Nursing education access programs have been introduced in a number of countries to address the shortage of healthcare providers of Aboriginal descent. An evaluation study of a nursing education access program in Labrador, Canada, was undertaken using a Responsive Evaluation approach. Interviews and focus groups with program stakeholders were conducted. Program effectiveness was influenced by culturally relevant curriculum, experiential and authentic learning opportunities, academic and social support, and the need for partnership building between stakeholders. The authors report key findings resulting from the Responsive Evaluation. [ABSTRACT FROM AUTHOR]

BACKGROUND: In May 2003, a survey questionnaire was distributed to all licensed primary care physicians in Newfoundland and Labrador. The objective was to examine the attitudes, self-reported practices, and continuing medical education (CME) preferences of primary care physicians as they pertain to prostate cancer screening. METHODS: Data was obtained from 485 primary care physicians using self-reports of prostate cancer screening practices, attitudes towards prostate cancer screening, and CME preferences. Respondents' characteristics were also collected (eg, gender, years of experience). RESULTS: A majority of respondents screen asymptomatic male patients for prostate cancer. Screening behaviour was related to high volume practice settings, fee-for-service and increased with patient age. Most common reasons for screening were family history, age of patient, and patient request. Majority of physicians agreed that prostate screening should be routinely performed on all men beginning at age 50, however half of physicians believe there is lack of evidence to support digital rectal examination (DRE) and one-third of physicians do not believe the prostate-specific antigen (PSA) nor DRE are accurate screening tests. Areas of greatest interest for CME included topics related to prostate cancer screening effectiveness, strategies for prevention, sexual dysfunction, available treatments and their side effects, and management options. CONCLUSION: Physicians are supportive of the value of screening, however the reliability of and evidence to support DRE and PSA as prostate cancer screening tests are in question. CME which addresses issues surrounding prostate screening and areas related to patient education and counselling are of greatest need. [ABSTRACT FROM AUTHOR]

The impact of breast cancer on the emotional and social health of women and their families is an important issue for the cancer field. Nevertheless, many patients do not avail themselves of support programmes. In rural communities there is often a lack of services, which, for many, leads to a perception of 'being alone' in the struggle to become better. This paper reports an evaluation of a pilot project to facilitate a self-help peer support group network: an extensive provincial audio teleconferencing network for rural breast cancer survivors, established by the Telemedicine Centre of the Memorial University of Newfoundland. A satisfaction questionnaire was distributed to participants in the pilot programme. Responses suggested that they were very satisfied with the use of audio teleconferencing for the facilitation of a social support programme. The programme appeared to help bridge the isolation gap that rural women with breast cancer often experience. The results have implications for the provision of self-help social support services through audio teleconferencing, as well as for the quality of life and wellbeing of rural women. [ABSTRACT FROM AUTHOR]

Background: Negative role models can significantly impact nursing students' adherence to standard infection control precautions (SP) but there has been limited research on impacts and relevant strategies., Purpose: This review examined the impact of negative role models on nursing students' adherence to SP and explored strategies that nursing instructors could use to help students effectively manage the influence of negative role models., Methods: An integrative review was conducted, guided by Whittemore and Knafl's methodology (2005). PubMed, CINAHL, and Scopus were searched for articles from 2008-2023. Research studies were critically appraised using appropriate tools., Results: Fourteen articles met the inclusion criteria and were included in this review. The literature indicates that nursing students frequently encounter negative role models during their clinical placements and that such negative encounters detrimentally impact their adherence to SP. Five strategies to potentially mitigate the impact of negative role models were identified., Conclusion: To address the issue of negative role models, nursing instructors can help students learn specific strategies to manage encounters with negative role models, promote discussion of role modeling with students and clinical staff, and act as role models themselves. Further research is needed to inform specific strategies., Competing Interests: Declaration of competing interest There is no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Unlabelled: Virtual care appointments expanded rapidly during COVID-19 out of necessity and to enable access and continuity of care for many patients. While previous work has explored health care providers' experiences with telehealth usage on small-scale projects, the broad-level adoption of virtual care during the pandemic has expounded opportunities for a better understanding of how to enhance the integration of telehealth as a regular mode of health care services delivery. Training and education for health care providers on the effective use of virtual care technologies are factors that can help facilitate improved adoption and use. We describe our approach to designing and developing an accredited continuing professional development (CPD) program using e-learning technologies to foster better knowledge and comfort among health care providers with the use of virtual care technologies. First, we discuss our approach to undertaking a systematic needs assessment study using a survey questionnaire of providers, key informant interviews, and a patient focus group. Next, we describe our steps in consulting with key stakeholder groups in the health system and arranging committees to inform the design of the program and address accreditation requirements. The instructional design features and aspects of the e-learning module are then described in depth, and our plan for evaluating the program is shared as well. As a CPD modality, e-learning offers the opportunity to enhance access to timely continuing professional education for health care providers who may be geographically dispersed across rural and remote communities., (© Vernon Curran, Robert Glynn, Cindy Whitton, Ann Hollett. Originally published in JMIR Medical Education (https://mededu.jmir.org).)

Background: The United States Medical Licensing Examination (USMLE) step 1 is one of the two examinations written after completion of the first two years (basic science stage) of medical school to be eligible to apply for residency training in the USA. A huge number and types of study materials are available to prepare for the exam which might confuse students choosing a resource. We investigated learning resources being used by the third and fifth-semester medical students and their association with academic performance. We also compared learning resources and exam scores of high-performing and low-performing students., Methods: Data collection was done using structured (quantitative study) and semi-structured (qualitative study) questionnaires during a face-to-face interview. This article is about the quantitative part which was designed as a correlational study. Single factor one-way analysis of variance (ANOVA), Pearson correlation coefficient test, T-test, and Fisher's exact test were used to analyze the data., Results: About half of all students used three or more commercial resources dealing with the same content. A weak negative correlation was observed between the number of commercial resources and the exam scores, especially when the number of these resources was three or more (r = -0.26). The mean exam score of textbook users was statistically significantly higher than the mean score of textbook non-users (p = 0.01). The usage of textbooks was statistically significantly higher in the cohort of top performers in comparison to the rest of the students (p = 0.006). In addition to less usage of textbooks, the mean number of review books was higher in the group of weakest students (2.84 versus 3.7; p = 0.75)., Conclusions: Most students did not use professional textbooks and about half used too many commercial review resources. While the former fact was significantly associated with poor academic performance, the later fact had weak negative correlation with exam score. Pedagogical interventions are urgently needed to make the right type of learning resources available by making professional textbooks more USMLE-oriented and helping the students choose the best and right number of resources for optimum academic performance. By fulfilling the observed needs of the students in this way, they might feel empowered because of self-determination which will motivate studies., (© 2024. The Author(s).)

Abstract: This systematic review, following PRISMA standards, aimed to assess the effectiveness of higher versus lower fidelity simulation on health care providers engaged in team training. A comprehensive search from January 1, 2011 to January 24, 2023 identified 1390 studies of which 14 randomized (n = 1530) and 5 case controlled (n = 257) studies met the inclusion criteria. The certainty of evidence was very low due to a high risk of bias and inconsistency. Heterogeneity prevented any metaanalysis. Limited evidence showed benefit for confidence, technical skills, and nontechnical skills. No significant difference was found in knowledge outcomes and teamwork abilities between lower and higher fidelity simulation. Participants reported higher satisfaction but also higher stress with higher fidelity materials. Both higher and lower fidelity simulation can be beneficial for team training, with higher fidelity simulation preferred by participants if resources allow. Standardizing definitions and outcomes, as well as conducting robust cost-comparative analyses, are important for future research., Competing Interests: Conflicts of Interest: This systematic review was part of the Society for Simulation in Healthcare guideline development process. A.L. is president of Resuscitation Council UK and a member of the International Liaison Committee on Resuscitation Education, Implementation and Teams taskforce. A.D. is a member of the International Liaison Committee on Resuscitation Education, Implementation and Teams task force. The other authors declare no conflict of interest., (Copyright © 2023 Society for Simulation in Healthcare.)

Introduction: Polydrug use patterns among young adults using ecstasy vary, as well as their willingness to change them. Polydrug use patterns are likely associated with different adverse health outcomes. It is unknown whether polydrug use patterns of young adults who use ecstasy are similar in different countries. This study aims to identify and compare polydrug use patterns and willingness to change them of young adults that use ecstasy in the United Kingdom (UK) and the Netherlands (NL), two countries with a high prevalence of ecstasy use and a large electronic dance music (EDM) scene., Methods: The data from the online cross-sectional Electronic Music Scene Survey were used in a latent class analysis. The binary indicators used in the estimation were past-year substance use of 21 different substances. The sample consisted of young adult ecstasy users that regularly visit EDM events (age 18-34)., Results: A total of 1,077 respondents from the UK (age M = 23.1) and 1,178 from the NL (age M = 23.7) that regularly visit EDM events were included in the analyses. In both countries, three polydrug use patterns of ecstasy users were identified based on Bayesian Information Criterion fit indices: a traditional polydrug use class (UK: 28%; NL: 40%), a stimulant and ketamine polydrug use class (UK: 48%; NL: 52%), and an extensive polydrug use class (UK: 24%; NL: 8%) characterized by substantial use of stimulants, depressant, and psychedelic substances. Overall, young adults that used ecstasy in the UK consumed 3,4-methylenedioxymeth-amphetamine (MDMA) more often as powder/crystalline and at higher dosages compared to young adults in the NL who preferred MDMA tablets. Regardless of polydrug class or country, most respondents indicated that they had the intention to reduce but not quit their use., Conclusion: In both countries, structurally similar polydrug use patterns among young adults that use ecstasy were found, while the use frequencies of individual substances and preferred MDMA form varied between the countries., (© 2023 S. Karger AG, Basel.)

Introduction: Reflective practice involves thinking about one's practice and often involves using data to effect such reflection. Multisource feedback (MSF) involves evaluation by peers, patients, and coworkers. Coaching has been identified as a key aspect of MSF with peer coaching involving two or more colleagues working together to reflect on current practices and share ideas. We introduced a pilot MSF and peer coaching program with a goal to evaluate its effect on fostering reflective practice., Methods: Physician participants completed a 360-degree assessment of their practices, followed by peer coaching sessions. Peer coaches were oriented to an evidence-based theory-driven feedback model (R2C2) to support coaching skills development. A mixed-methods evaluation study was undertaken, including pre to post surveys of readiness for self-directed learning, a postevaluation survey of participant satisfaction, and semistructured participant interviews., Results: Thirty four (N = 34) participants completed the 360-degree assessment, and 22 participants took part in two coaching meetings. Respondents reported significant improvement to aspects of their readiness for self-directed learning ( P <.05), including knowing about learning strategies to achieve key learning goals, knowing about resources to support one's own learning, and being able to evaluate one's learning outcomes. Overall, respondents felt empowered to "reflect" on their practices, affirm what they were doing well, and, for some, identify opportunities for further and ongoing professional development., Discussion: MSF and peer coaching emerged as key elements in enabling reflective practice by facilitating reflection on one's practice and conversations with one's peers to affirm strengths and opportunities for strengthening practice through self-directed professional development., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 The Alliance for Continuing Education in the Health Professions, the Association for Hospital Medical Education, and the Society for Academic Continuing Medical Education.)

Introduction: Virtual care has expanded during COVID-19 and enabled continued access to healthcare services. As with the introduction of any new technology in healthcare delivery, the preparation of healthcare providers for adopting and using such systems is imperative. The purpose of this qualitative study was to explore experts' ascribed opinions on healthcare providers' continuing professional development (CPD) needs in virtual care., Methods: Semistructured interviews were conducted with a purposive sample of key informants representing Canadian provincial and national organizations with expertise in virtual care delivery., Results: Three main areas of knowledge, skills, and abilities that would be most helpful for healthcare providers in preparing to adopt and use virtual care were identified. The use of technology necessitates knowledge of how to integrate technology and virtual care in the practice workflow. This includes knowing how to use the technology and the privacy and security of the technology. Providers need to be able to adapt their clinical skills to virtual care and build rapport through good communication with patients. Virtual care is not appropriate for all visits, therefore providers need to understand when an in-person visit is necessary with respect to the nature of the appointment, as well as contextual factors for individual patients. Finally, providers need to adapt their examination skills to virtual care., Discussion: Beyond the COVID-19 pandemic, virtual care will have a continuing role in enhancing continuity of care through access that is more convenient. Key informants identified barriers and challenges in adopting and using virtual care effectively, fundamental knowledge, skills and/or abilities required, and important topics and/or educational experiences to guide CPD program development on virtual care for healthcare providers., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Objective: To determine if e-learning interventions are efficient to review Neonatal Resuscitation Program (NRP) and to prevent performance deterioration in neonatal resuscitation of already-certified healthcare professionals., Study Design: In this scoping review, we searched for manuscripts published until June 2020 in five databases. We included all studies on e-learning use for NRP review in already-certified healthcare providers., Results: Among 593 abstracts retrieved, 38 full-text articles were assessed for eligibility. Five studies were included. Four studies evaluated the effectiveness of e-learning interventions immediately or months after their completion by providers. These interventions did not consistently enhance their NRP knowledge and their performance. One study showed that a growth mindset can influence positively neonatal resuscitation performance after an e-learning simulation., Conclusion: There is not enough evidence to conclude that e-learning interventions can prevent neonatal resuscitation knowledge and performance decay in already-certified providers. More research is needed on the use of e-learning simulation-based scenarios to improve NRP retention., (© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Background: Cannabis use is common, especially among young people, and is associated with risks for various health harms. Some jurisdictions have recently moved to legalization/regulation pursuing public health goals. Evidence-based 'Lower Risk Cannabis Use Guidelines' (LRCUG) and recommendations were previously developed to reduce modifiable risk factors of cannabis-related adverse health outcomes; related evidence has evolved substantially since. We aimed to review new scientific evidence and to develop comprehensively up-to-date LRCUG, including their recommendations, on this evidence basis., Methods: Targeted searches for literature (since 2016) on main risk factors for cannabis-related adverse health outcomes modifiable by the user-individual were conducted. Topical areas were informed by previous LRCUG content and expanded upon current evidence. Searches preferentially focused on systematic reviews, supplemented by key individual studies. The review results were evidence-graded, topically organized and narratively summarized; recommendations were developed through an iterative scientific expert consensus development process., Results: A substantial body of modifiable risk factors for cannabis use-related health harms were identified with varying evidence quality. Twelve substantive recommendation clusters and three precautionary statements were developed. In general, current evidence suggests that individuals can substantially reduce their risk for adverse health outcomes if they delay the onset of cannabis use until after adolescence, avoid the use of high-potency (THC) cannabis products and high-frequency/-intensity of use, and refrain from smoking-routes for administration. While young people are particularly vulnerable to cannabis-related harms, other sub-groups (e.g., pregnant women, drivers, older adults, those with co-morbidities) are advised to exercise particular caution with use-related risks. Legal/regulated cannabis products should be used where possible., Conclusions: Cannabis use can result in adverse health outcomes, mostly among sub-groups with higher-risk use. Reducing the risk factors identified can help to reduce health harms from use. The LRCUG offer one targeted intervention component within a comprehensive public health approach for cannabis use. They require effective audience-tailoring and dissemination, regular updating as new evidence become available, and should be evaluated for their impact., Competing Interests: Declarations of Interest The authors make the following declarations of relevant financial activities outside of the submitted work: Prof. B. Fischer has received general research support from the Hugh Green Foundation Chair in Addiction Research, held at the Faculty of Medical and Health Sciences, University of Auckland, New Zealand. In the past 3 years, he has held research grants and contracts in the areas of substance use, health and policy from public funding and government (i.e., public-only) organizations. Prof. C. Bullen has received research support from the Health Research Council of New Zealand, Heart Foundation of New Zealand, and Pfizer. In 2019 he provided consultancy on nicotine dependence for Johnson & Johnson (Japan). Prof. V. Curran declares general research support from the United Kingdom Medical Research Council and the United Kingdom Department of Health. In the past, she has consulted for Janssen Pharmaceuticals on the treatment of resistant depression. Prof. D. Jutras-Aswad has received investigational products (last in 2018) from Insys Therapeutics for a clinical trial funded by the Canadian Institutes of Health Research (CIHR). In the last 36 months, he has received grants/contracts support for substance use-related research from public and governmental agencies and has expert-consulted on related issues with public/government agencies. Prof. W. van den Brink has received financial support from Lundbeck, Novartis, Bioproject, Kinnov Therapeutics, Recordati, Mundipharma, Angelini, Opiant Pharmaceuticals, Indivior, Camurus, and Takeda., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: OSCE are widely used for assessing clinical skills training in medical schools. Use of traditional pass fail cut off yields wide variations in the results of different cohorts of students. This has led to a growing emphasis on the application of standard setting procedures in OSCEs., Purpose/aim: The purpose of the study was comparing the utility, feasibility and appropriateness of 4 different standard setting methods with OSCEs at XUSOM., Methods: A 15-station OSCE was administered to 173 students over 6 months. Five stations were conducted for each organ system (Respiratory, Gastrointestinal and Cardiovascular). Students were assessed for their clinical skills in 15 stations. Four different standard setting methods were applied and compared with a control (Traditional method) to establish cut off scores for pass/fail decisions., Results: OSCE checklist scores revealed a Cronbach's alpha of 0.711, demonstrating acceptable level of internal consistency. About 13 of 15 OSCE stations performed well with "Alpha if deleted values" lower that 0.711 emphasizing the reliability of OSCE stations. The traditional standard setting method (cut off score of 70) resulted in highest failure rate. The Modified Angoff Method and Relative methods yielded the lowest failure rates, which were typically less than 10% for each system. Failure rates for the Borderline methods ranged from 28% to 57% across systems., Conclusions: In our study, Modified Angoff method and Borderline regression method have shown to be consistently reliable and practically suitable to provide acceptable cut-off score across different organ system. Therefore, an average of Modified Angoff Method and Borderline Regression Method appeared to provide an acceptable cutoff score in OSCE. Further studies, in high-stake clinical examinations, utilizing larger number of judges and OSCE stations are recommended to reinforce the validity of combining multiple methods for standard setting., Competing Interests: Declaration of Conflicting Interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Introduction: There is global recognition that low back pain (LBP) should be managed with a biopsychosocial approach. Previous implementation of this approach resulted in low uptake and highlighted the need for ongoing support. This study aims to explore the feasibility of (i) training and using a champion to support implementation, (ii) using a cluster randomised controlled trial (RCT), (iii) collecting patient reported outcome measures in a Canadian public healthcare setting and to identify contextual barriers to implementation., Methods: A pragmatic cluster RCT with embedded qualitative study with physiotherapists treating LBP in publicly funded physiotherapy departments in Newfoundland and Labrador, Canada. Participants will complete a previously developed online training course to equip them to deliver a biopsychosocial intervention for LBP. Clusters randomised to the intervention arm will receive additional support from a champion. A minimum champion training package has been developed based on known barriers in the literature. This includes strategies to target barriers relating to group-based scheduling issues, lack of managerial support, perceived patient factors such as addressing patient expectations for other types of treatments or selecting which patients might be best suited for this intervention, and anxiety about delivering something new. This package will be further codeveloped with study champions based on identified implementation barriers using the Behaviour Change Wheel. Clusters will be monitored for 6 months to assess champion and physiotherapist recruitment and retention, acceptability and implementation of the champion training, and the viability of conducting a cluster RCT in this setting. A purposive sample of physiotherapists will be interviewed from both arms., Ethics and Dissemination: This study was approved by Newfoundland and Labrador Health Research Ethics Authority in December 2018. Results will be disseminated to academic audiences through conferences and peer reviewed publications; to all study participants, their clinical leads, and patients with LBP., Trial Registration Number: ClinicalTrials.gov Identifier: NCT04377529; Memorial University of Newfoundland Protocol Record 20190025; Pre-results., Competing Interests: Competing interests: ZH provides private training to healthcare professionals in cognitive behavioural therapy., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Despite the advantages of having a child as a medical resident, the transition back to residency after parental leave can be challenging. This study is the first to investigate this issue using a nation-wide Canadian sample of both residents and program directors., Method: A questionnaire was developed and made available online. Respondents included 437 female residents, 33 male residents, and 172 residency program directors. The mean length of parental leave was nine months for female residents and six weeks for male residents. Almost all female residents (97.5%) breastfed with an average duration of 12 months. The top challenges reported by residents were feeling guilty for being away from their family, long and unpredictable work hours, sleep deprivation, and finding time to study. When female residents and program directors were matched to both school and program ( N = 99 pairs), there was no difference in the total number of challenges reported, but program directors reported offering significantly more accommodations than female residents reported being offered, t(196) = 13.06, p < .001., Results: Our data indicate there is a need for better communication between resident parents and program directors, as well as clear program-specific parental leave policies, particularly for supporting breastfeeding mothers as they return to work., Competing Interests: Conflicts of interest: There were no conflicts of interest to report., (© 2020 Willoughby, Julien, Zendel, Curran; licensee Synergies Partners.)

YouTube has emerged as a growing educational resource for medical learners and educators; yet, its broad implementation may lack guidance from evidence-based evaluations. This article presents a scoping review of the utility, effectiveness, and validity of YouTube video resources in medical education. Of the 113 articles identified, 31 articles met inclusion criteria that focused on use of YouTube in medical education. Only 19.4% of the articles ( n  = 6) reported evaluative outcomes related to the use of YouTube for instructional purposes. Recommendations are offered for improving the usefulness and quality of YouTube videos as an educational resource in medical education., Competing Interests: Conflict of InterestThe authors declare that there is no conflict of interest., (© International Association of Medical Science Educators 2020.)

Introduction: Physicians are often challenged with accessing relevant up-to-date arthritis information to enable the delivery of optimal care. An online continuing medical education programme to disseminate arthritis clinical practice guidelines (CPGs) was developed to address this issue., Methods: Online learning modules were developed for osteoarthritis (OA) and rheumatoid arthritis (RA) using published CPGs adapted for primary care (best practices), input from subject matter experts and a needs assessment. The programme was piloted in two rural/remote areas of Canada. Knowledge of best practice guidelines was measured before, immediately after completion of the modules and at 3-month follow-up by assigning one point for each appropriate best practice applied to a hypothetical case scenario. Points were then summed into a total best practice score., Results: Participants represented various professions in primary care, including family physicians, physiotherapists, occupational therapists and nurses (n = 89) and demonstrated significant improvements in total best practice scores immediately following completion of the modules (OA pre = 2.8/10, post = 3.8/10, P < 0.01; RA pre = 3.9/12, post = 4.6/12, P < 0.01). The response rate at 3 months was too small for analysis., Conclusions: With knowledge gained from the online modules, participants were able to apply a greater number of best practices to OA and RA hypothetical case scenarios. The online programme has demonstrated that it can provide some of the information rural/remote primary care providers need to deliver optimal care; however, further research is needed to determine whether these results translate into changes in practice., Competing Interests: None

Introduction: Health and human services professionals are increasingly using mobile devices to support clinical decision-making and evidence-based practice. However, research on self-directed learning in an era of growing digital technology utilization is underdeveloped. This study explored the adoption and use of mobile learning as a continuing professional development (CPD) activity., Methods: A mixed-methods case study using semistructured interviews and a web-based questionnaire was conducted with health and human services professionals in Newfoundland and Labrador, Canada., Results: Respondents reported using a smartphone (53.8%), tablets (50.4%), YouTube (43.0%), and mobile apps (35.8%) for CPD. The highest-rated benefits of mobile learning included improved access to information (M = 3.51); potential for enhanced knowledge acquisition (M = 3.45); staying up to date (M = 3.44); and verifying information (M = 3.40). The greatest barriers included cost of some apps and resources (M = 3.07); websites/programs not functional on mobile devices (M = 2.84); workplace barriers preventing access to digital resources (M = 2.82); and social media use linked to negative perceptions of professionalism (M = 2.65). Interview respondents described the flexibility and convenience of mobile learning, the level of autonomy it offered, and the advantages of learning on their own time. Technical issues, particularly for rural and remote practitioners, and digital professionalism also emerged as potential barriers., Discussion: A systems model organizes the factors influencing the adoption and use of mobile devices and resources to support "just-in-time" learning. Addressing policies, practices, and regulations that enable or inhibit adoption of mobile learning for CPD may foster enhanced use to support better clinical decision-making, improved accuracy, and greater patient safety.

Background: Very late-onset (aged ≥ 60 years) schizophrenia-like psychosis (VLOSLP) occurs frequently but no placebo-controlled, randomised trials have assessed the efficacy or risks of antipsychotic treatment. Most patients are not prescribed treatment., Objectives: The study investigated whether or not low-dose amisulpride is superior to placebo in reducing psychosis symptoms over 12 weeks and if any benefit is maintained by continuing treatment thereafter. Treatment safety and cost-effectiveness were also investigated., Design: Three-arm, parallel-group, placebo-controlled, double-blind, randomised controlled trial. Participants who received at least one dose of study treatment were included in the intention-to-treat analyses., Setting: Secondary care specialist old age psychiatry services in 25 NHS mental health trusts in England and Scotland., Participants: Patients meeting diagnostic criteria for VLOSLP and scoring > 30 points on the Brief Psychiatric Rating Scale (BPRS)., Intervention: Participants were randomly assigned to three arms in a two-stage trial: (1) 100 mg of amisulpride in both stages, (2) amisulpride then placebo and (3) placebo then amisulpride. Treatment duration was 12 weeks in stage 1 and 24 weeks (later reduced to 12) in stage 2. Participants, investigators and outcome assessors were blind to treatment allocation., Main Outcome Measures: Primary outcomes were psychosis symptoms assessed by the BPRS and trial treatment discontinuation for non-efficacy. Secondary outcomes were extrapyramidal symptoms measured with the Simpson-Angus Scale, quality of life measured with the World Health Organization's quality-of-life scale, and cost-effectiveness measured with NHS, social care and carer work loss costs and EuroQol-5 Dimensions., Results: A total of 101 participants were randomised. Ninety-two (91%) participants took the trial medication, 59 (64%) completed stage 1 and 33 (56%) completed stage 2 treatment. Despite suboptimal compliance, improvements in BPRS scores at 12 weeks were 7.7 points (95% CI 3.8 to 11.5 points) greater with amisulpride than with placebo (11.9 vs. 4.2 points; p  = 0.0002). In stage 2, BPRS scores improved by 1.1 point in those who continued with amisulpride but deteriorated by 5.2 points in those who switched from amisulpride to placebo, a difference of 6.3 points (95% CI 0.9 to 11.7 points; p  = 0.024). Fewer participants allocated to the amisulpride group stopped treatment because of non-efficacy in stages 1 ( p  = 0.01) and 2 ( p  = 0.031). The number of patients stopping because of extrapyramidal symptoms and other side effects did not differ significantly between groups. Amisulpride treatment in the base-case analyses was associated with non-significant reductions in combined NHS, social care and unpaid carer costs and non-significant reductions in quality-adjusted life-years (QALYs) in both stages. Including patients who were intensive users of inpatient services in sensitivity analyses did not change the QALY result but resulted in placebo dominance in stage 1 and significant reductions in NHS/social care (95% CI -£8923 to -£122) and societal costs (95% CI -£8985 to -£153) for those continuing with amisulpride., Limitations: The original recruitment target of 300 participants was not achieved and compliance with trial medication was highly variable., Conclusions: Low-dose amisulpride is effective and well tolerated as a treatment for VLOSLP, with benefits maintained by prolonging treatment. Potential adverse events include clinically significant extrapyramidal symptoms and falls., Future Work: Trials should examine the longer-term effectiveness and safety of antipsychotic treatment in this patient group, and assess interventions to improve their appreciation of potential benefits of antipsychotic treatment and compliance with prescribed medication., Trial Registration: Current Controlled Trials ISRCTN45593573 and EudraCT2010-022184-35., Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 22, No. 67. See the NIHR Journals Library website for further project information., Competing Interests: Robert Howard reports membership of the Heath Technology Assessment (HTA) Commissioning Board. Peter Bentham reports grants from the HTA programme during the course of this study. Craig Ritchie reports grants and personal fees from Merck Sharp & Dohme Ltd (Kenilworth, NJ, USA), personal fees from Pfizer Inc. (New York City, NY, USA), Eisai Co. Ltd (Tokyo, Japan), Actinogen (Sydney, NSW, Australia), Kyowa Hakko Kirin (Tokyo, Japan), Eli Lilly and Company (Indianapolis, IN, USA), and F. Hoffmann-La Roche AG (Basel, Switzerland), grants from Biogen Inc. (Cambridge, MA, USA) and grants and non-financial support from Janssen EMEA (Beerse, Belgium) and Takeda Pharmaceutical Company Ltd (Osaka, Japan) during the conduct of the study. Craig Ritchie was also the co-coordinator and academic lead for the European Prevention of Alzheimer’s Dementia (EPAD) project, which has numerous commercial partners in keeping with the mechanisms of the European Union’s Innovative Medicine’s Initiative [i.e. Janssen, Eisai Co. Ltd, Pfizer, Eli Lilly and Company, Roche Diagnostics (Risch-Rotkreuz, Switzerland), Boehringher Ingelheim GmbH (Ingelheim am Rhein, Germany), Novartis International AG (Basel, Switzerland), AC Immune SA (Lausanne, Switzerland), IXICO (London, UK), Aridhia (Glasgow, UK), Amgen Inc. (Thousand Oaks, CA, USA), Berry Consultants (Abingdon, UK), H. Lundbeck A/S (Copenhagen, Denmark), Sanofi SA (Paris, France), IQVIA (formerly Quintiles IMS Holdings, Inc.) (Durham, NC, USA) and Takeda Pharmaceutical Company]. Andrew Sommerlad reports grants from the Wellcome Trust outside the submitted work. Ramin Nilforooshan reports personal fees from Eli Lilly and Company and non-financial support from Janssen outside the submitted work. Martin Knapp reports grants from Merck Sharp & Dohme outside the submitted work.