Andy Pulman

Enabling interprofessional education: The role of technology to enhance learning

Interprofessional education (IPE) in health and social care undergraduate education is a key governmental driver [DOH, 2001. Working Together, Learning Together. A Framework for Lifelong Learning in the NHS. HMSO, London]. In the UK, IPE has been advocated and developed as a means to encourage effective collaboration in order to improve public sector services [Barr, H., Ross, F., 2006. Mainstreaming interprofessional education in the United Kingdom: a position paper. Journal of Interprofessional Care 20 (2), 96-104]. An IPE curriculum was introduced at the School of Health & Social Care for undergraduate students (n=600) from a variety of health and social care disciplines. As a part of this process, there was a demand for ways to allow students and staff to interact and collaborate through learning resources at different locations and times in order to learn interprofessionally. Blended learning was the chosen approach leading to the development of a simulated web-based community learning resource - Wessex Bay. This paper considers the development of Wessex Bay from technical and pedagogical perspectives. The curricular context for the development is considered and the role of simulation in meeting educational needs is explored. The technical development is outlined followed by an overview of an evaluation of its use in the first two years of the IPE programme. Conclusions are drawn around the strengths and limitations of this approach, including a consideration of further opportunities for developmental work.

Munchausen by Internet: Current Research and Future Directions

Background The Internet has revolutionized the health world, enabling self-diagnosis and online support to take place irrespective of time or location. Alongside the positive aspects for an individual’s health from making use of the Internet, debate has intensified on how the increasing use of Web technology might have a negative impact on patients, caregivers, and practitioners. One such negative health-related behavior is Munchausen by Internet. Objective Munchausen by Internet occurs when medically well individuals fake recognized illnesses in virtual environments, such as online support groups. This paper focuses on the aspect of Munchausen by Internet in which individuals actively seek to disrupt groups for their own satisfaction, which has not yet been associated with the wider phenomena of Internet trolls (users who post with the intention of annoying someone or disrupting an online environment). Methods A wide-ranging review was conducted to investigate the causes and impacts of online identity deception and Munchausen by Internet drawing on academic research and case studies reported online and in the media. Results The limited research relating to motivation, opportunity, detection, effects, and consequences of Munchausen by Internet is highlighted and it is formally linked to aspects of trolling. Case studies are used to illustrate the phenomenon. What is particularly worrying is the ease with which the deception can be carried out online, the difficulty in detection, and the damaging impact and potential danger to isolated victims. Conclusions We suggest ways to deal with Munchausen by Internet and provide advice for health group facilitators. We also propose that Munchausen by Internet and Munchausen by Internet trolling should be formally acknowledged in a revised version of the Diagnostic and Statistical Manual DSM-5. This will assist in effectively identifying and minimizing the growth of this behavior as more people seek reassurance and support about their health in the online environment. We also suggest directions for future research.

A patient centred framework for improving LTC quality of life through Web 2.0 technology.

The NHS and Social Care Model — a blueprint supporting organisations in improving services for people with long-term conditions (LTCs) — noted options to support people with LTCs might include technological tools supporting personalised care and choice and providing resources for patients to self-care and self-manage. Definitions concerning the integration of health information and support with Web 2.0 technology are primarily concerned with approaches from the healthcare perspective. There is a need to design a patient centred framework, encapsulating the use of Web 2.0 technology for people with LTCs who want to support, mitigate or improve quality of life. Existing theoretical frameworks offer a means of informing the design and measurement of this framework. This article describes how Web 2.0 technology could impact on the quality of life of individuals with LTCs and suggests a starting point for developing a theoretically informed patient centred framework.

Ideas and enhancements related to mobile applications to support type 1 diabetes

Background Mobile devices have become increasingly important to young people who now use them to access a wide variety of health-related information. Research and policy related to the integration of health information and support with this technology do not effectively consider the viewpoint of a younger patient. Views of young people with type 1 diabetes are vital in developing quality services and improving their own health-related quality of life (HRQOL), yet research on their lifestyle and use of Web and mobile technology to support their condition and in non–health-related areas is sparse. Objective To develop insight into young people with type 1 diabetes and their current use of Web and mobile technology and its potential impact on HRQOL. This can be achieved by constructing an in-depth picture of their day-to-day experiences from qualitative interviewing and exploring how they make use of technology in their lives and in relation to their condition and treatment. The goal was then to build something to help them, using the researcher’s technical expertise and seeking users’ opinions during the design and build, utilizing sociotechnical design principles. Methods Data were collected by semistructured, in-depth qualitative interviews (N=9) of young people with type 1 diabetes aged 18-21. Interviews were transcribed and loaded onto NVivo for theme identification. Data analysis was undertaken during initial interviews (n=4) to locate potential ideas and enhancements for technical development. Latter interviews (n=5) assisted in the iterative sociotechnical design process of the development and provided additional developmental ideas. Results Six themes were identified providing an understanding of how participants lived with and experienced their condition and how they used technology. Four technological suggestions for improvement were taken forward for prototyping. One prototype was developed as a clinically approved app. A number of ideas for new mobile apps and enhancements to currently existing apps that did not satisfactorily cater to this age group’s requirements for use in terms of design and functionality were suggested by interviewees but were not prototyped. Conclusions This paper outlines the nonprototyped suggestions from interviewees and argues that young people with type 1 diabetes have a key role to play in the design and implementation of new technology to support them and improve HRQOL. It is vital to include and reflect on their suggestions as they have a radically different view of technology than either their parents or practitioners. We need to consider the relationship to technology that young people with type 1 diabetes have, and then reflect on how this might make a difference to them and when it might not be a suitable mechanism to use.

A Virtual Infection Control Simulation: The Development of a Serious Game in the Health-Care Sector

National Statistics Online (2005) note that the number of death certificates mentioning Staphylococcus aureus (S. aureus) infection increased each year from 1993 to 2005 in England and Wales. This increase in infection rates highlights the importance of encouraging greater education concerning washing with soap and water or using an alcohol-based hand rub.

Innovative mobile technology alcohol education for young people with type 1 diabetes

Views of young people with type 1 diabetes are vital in developing quality services and improving health‐related quality of life (HRQoL), yet research on their lifestyle and use of web and mobile technology to support their condition and in non‐health related areas is sparse. The aim of this research was to develop an insight into young peoples current use of web and mobile technology and its potential impact on HRQoL by constructing an in‐depth picture of their day‐to‐day experiences, exploring how they made use of technology in their lives and in relation to their condition and treatment – then, building something to help them.

The carer’s world: An interactive reusable learning object

Visual and interactive environments offer unique opportunities for emotive and immersive experiences related to health. Examples concerning Alzheimer’s include the film Ex memoria, documentaries like Malcolm and Barbara: Love’s farewell and the Remember us virtual exhibit within Second life. In 2006, the School of Health and Social Care (HSC) began experimenting with integrating the methods and themes of Lifeworld with Hypertext narrative into an educational resource. This process led to the development of a reusable learning object — The carer’s world — designed to give users greater knowledge about, and insight into, the challenges of caring for people with Alzheimer’s. This article describes the context, processes and influences of its creation and a discussion of how this type of development might increase knowledge and understanding around the issues of a carer’s world and also provide a tool for embedding into the higher educational health curriculum.

Effectiveness of the Malnutrition eLearning Course for Global Capacity Building in the Management of Malnutrition: Cross-Country Interrupted Time-Series Study

Background Scaling up improved management of severe acute malnutrition has been identified as the nutrition intervention with the largest potential to reduce child mortality, but lack of operational capacity at all levels of the health system constrains scale-up. We therefore developed an interactive malnutrition eLearning course that is accessible at scale to build capacity of the health sector workforce to manage severely malnourished children according to the guidelines of the World Health Organization. Objective The aim of this study was to test whether the malnutrition eLearning course improves knowledge and skills of in-service and preservice health professionals in managing children with severe acute malnutrition and enables them to apply the gained knowledge and skills in patient care. Methods This 2-year prospective, longitudinal, cross-country, interrupted time-series study took place in Ghana, Guatemala, El Salvador, and Colombia between January 2015 and February 2017. A subset of 354 in-service health personnel from 12 hospitals and 2 Ministries of Health, 703 preservice trainees from 9 academic institutions, and 204 online users participated. Knowledge gained after training and retention over time was measured through pre- and postassessments comprising questions pertaining to screening, diagnosis, pathophysiology and treatment, and prevention of malnutrition. Comprehension, application, and integration of knowledge were tested. Changes in perception, confidence, and clinical practice were assessed through questionnaires and interviews. Results Before the course, awareness of the World Health Organization guidelines was 36.73% (389/1059) overall, and 26.3% (94/358) among in-service professionals. The mean score gain in knowledge after access to the course in 606 participants who had pre- and postassessment data was 11.8 (95% CI 10.8-12.9; P<.001)—a relative increase of 41.5%. The proportion of participants who achieved a score above the pass mark posttraining was 58.7% (356/606), compared with 18.2% (110/606) in pretraining. Of the in-service professionals, 85.9% (128/149) reported applying their knowledge by changing their clinical practice in screening, assessment, diagnosis, and management. This group demonstrated significantly increased retained knowledge 6 months after training (mean difference [SD] from preassessment of 12.1 [11.8]), retaining 65.8% (12.1/18.4) of gained knowledge from the training. Changes in the management of malnutrition were reported by trained participants, and institutional, operational, and policy changes were also found. Conclusions The malnutrition eLearning course improved knowledge, understanding, and skills of health professionals in the diagnosis and management of children with severe acute malnutrition, and changes in clinical practice and confidence were reported following the completion of the course.