Iain Doherty

MEMO--a mobile phone depression prevention intervention for adolescents: development process and postprogram findings on acceptability from a randomized controlled trial.

Background Prevention of the onset of depression in adolescence may prevent social dysfunction, teenage pregnancy, substance abuse, suicide, and mental health conditions in adulthood. New technologies allow delivery of prevention programs scalable to large and disparate populations. Objective To develop and test the novel mobile phone delivery of a depression prevention intervention for adolescents. We describe the development of the intervention and the results of participants’ self-reported satisfaction with the intervention. Methods The intervention was developed from 15 key messages derived from cognitive behavioral therapy (CBT). The program was fully automated and delivered in 2 mobile phone messages/day for 9 weeks, with a mixture of text, video, and cartoon messages and a mobile website. Delivery modalities were guided by social cognitive theory and marketing principles. The intervention was compared with an attention control program of the same number and types of messages on different topics. A double-blind randomized controlled trial was undertaken in high schools in Auckland, New Zealand, from June 2009 to April 2011. Results A total of 1348 students (13–17 years of age) volunteered to participate at group sessions in schools, and 855 were eventually randomly assigned to groups. Of these, 835 (97.7%) self-completed follow-up questionnaires at postprogram interviews on satisfaction, perceived usefulness, and adherence to the intervention. Over three-quarters of participants viewed at least half of the messages and 90.7% (379/418) in the intervention group reported they would refer the program to a friend. Intervention group participants said the intervention helped them to be more positive (279/418, 66.7%) and to get rid of negative thoughts (210/418, 50.2%)—significantly higher than proportions in the control group. Conclusions Key messages from CBT can be delivered by mobile phone, and young people report that these are helpful. Change in clinician-rated depression symptom scores from baseline to 12 months, yet to be completed, will provide evidence on the effectiveness of the intervention. If proven effective, this form of delivery may be useful in many countries lacking widespread mental health services but with extensive mobile phone coverage. ClinicalTrial Australia New Zealand Clinical Trials Registry (ACTRN): 12609000405213; http://www.anzctr.org.au/trial_view.aspx?ID=83667 (Archived by WebCite at http://www.webcitation.org/64aueRqOb)

How we flipped the medical classroom

Abstract Flipping the classroom centres on the delivery of print, audio or video based material prior to a lecture or class session. The class session is then dedicated to more active learning processes with application of knowledge through problem solving or case based scenarios. The rationale behind this approach is that teachers can spend their face-to-face time supporting students in deeper learning processes. In this paper we provide a background literature review on the flipped classroom along with a three step approach to flipping the classroom comprising implementing, enacting and evaluating this form of pedagogy. Our three step approach is based on actual experience of delivering a flipped classroom at the University of Hong Kong. This initiative was evaluated with positive results. We hope our experience will be transferable to other medical institutions.

Contemporary and future eLearning trends in medical education

What follows is a consideration of three current eLearning trends – Massive Open Online Courses (MOOCs), tablet computing, and learning analytics – and a discussion as to whether these trends might disrupt what Ellaway sees as a period of consolidation in medical eLearning (Ellaway 2011). The eLearning innovations that we consider are taken from the NMC Horizon Report: 2013 Higher Education Edition, a wellknown series of publications which looks at how technologies might impact on education in the short, medium, and long term. The 2013 report identifies MOOCs, tablet computing, and learning analytics as potentially having a significant impact on education (Johnson et al. 2013). In our view, each trend has the potential to bring about changes in medical education. However, if the three trends come together, then there may be a single force for change that could be significant for medical education. We will explore this idea and critically discuss the issues in the final section of the paper.

The Quality of Life of Medical Students Studying in New Zealand: A Comparison With Nonmedical Students and a General Population Reference Group

Background: Quality of life is an essential component of learning and has strong links with the practice and study of medicine. There is burgeoning evidence in the research literature to suggest that medical students are experiencing health-related problems such as anxiety, depression, and burnout. Purpose: The aim of the study was to investigate medical students’ perceptions concerning their quality of life. Methods: Two hundred seventy-four medical students studying in their early clinical years (response rate = 80%) participated in the present study. Medical students were asked to fill in the abbreviated version of the World Health Organization Quality of Life questionnaire to elicit information about their quality of life perceptions in relation to their physical health, psychological health, social relationships, and environment. Subsequently, their responses were compared with two nonmedical students groups studying at a different university in the same city and an Australian general population norm. The findings were compared using independent groups t tests, confidence intervals, and Cohens d. Results: The main finding of the study indicated that medical students had similar quality of life perceptions to nonmedical students except in relation to the environment domain. Furthermore, the medical student group scored lower than the general population reference group on the physical health, psychological health, and environment quality of life domains. Conclusions: The results suggest that all university students are expressing concerns related to quality of life, and thus their health might be at risk. The findings in this study provided no evidence to support the notion that medical students experience lower levels of quality of life compared to other university students. When compared to the general population, all student groups examined in this study appeared to be experiencing lower levels of quality of life. This has implications for pastoral support, educationalists, student support personnel, and the university system.

Quality of life: international and domestic students studying medicine in New Zealand

International students form a significant proportion of students studying within universities in Western countries. The quality of life perceptions of international medical students in comparison with domestic medical students has not been well documented. There is some evidence to suggest that international medical students may have different educational and social experiences in relation to their domestic peers. This study investigates the levels of quality of life experienced by international and domestic students studying medicine. A total of 548 medical students completed the abbreviated version of the World Health Organization Quality of Life questionnaire. The focus of the analysis was to evaluate differences between international and domestic students in their early clinical years. The responses were analysed using multivariate analysis of variance methods. International medical students are experiencing lower social and environmental quality of life compared with domestic peers. International medical students in New Zealand have expressed quality of life concerns, which likely have an impact on their academic achievement, feelings of wellness, acculturation, and social adaptation. The findings reinforce the need for creating stronger social networks and accessible accommodation, as well as developing systems to ensure safety, peer mentorship and student support.

Motivation to Learn, Quality of Life and Estimated Academic Achievement: Medical Students Studying in New Zealand

The quality of life of medical students and their motivation to learn are critical factors that have an impact on their ability to learn. The aim of this study was to investigate the associations between medical students’ perceptions of their quality of life, motivation to learn, and estimated grade at the end of the academic year. Two hundred and seventy-four medical students at years four and five of medical school participated in the study. Students filled in a demographic survey form, and shortened versions of the World Health Organization Quality of Life Questionnaire and the Motivated Strategies for Learning Questionnaire. Significant correlations between quality of life and motivation to learn measures were obtained. Second, students who scored high on aspects of quality of life and motivation to learn also scored significantly higher on estimates of written grade. In conclusion, the results suggest that medical students’ perceptions about quality of life and motivation to learn are linked to estimation of academic achievement. The findings of this study further resonate with a key conceptual model in the motivation literature, which promotes the importance of creating opportunities for mastery learning, engaging task value, producing optimal learning contexts, and creating mechanisms for coping with and managing the inevitable anxiety-provoking learning experiences that medical students face.

Medical Students in Early Clinical Training and Achievement Motivation: Variations According to Gender, Enrollment Status, and Age

The purpose of this study was to examine the achievement motivation perceptions of medical students in early clinical training, to find out if variations in such perceptions may relate to students’ gender, age, ethnicity, or enrolment status (domestic or international). The participants were 272 4th and 5th year medical students who voluntarily completed the short version of the Motivated Strategies for Learning Questionnaire. The students’ scores in self-efficacy, intrinsic value, test anxiety, cognitive strategy use, and self-regulation, derived from the questionnaire, were analyzed in relation to the students’ gender, ethnicity, and enrolment status, along with their age as a possible covariate. Female students evidenced lower self-efficacy and higher test anxiety compared to their male counterparts. Likewise, international students were found to have lower self-efficacy and higher test anxiety compared to domestic students; the international students also scored lower in intrinsic value perception. Age was found to significantly correlate with self-efficacy, test anxiety, and intrinsic value perception. The findings suggest a need to use strategies like role-modeling to counteract the possible detrimental effects of negative gender stereotyping on female students’ self-efficacy — especially female students from non-Western cultural backgrounds. The higher levels of test anxiety evidenced by some groups may be understandable in the context of clinical training, but nevertheless indicate a need for the formulation and provision of appropriate forms of skills training and support for students — including communication skills training and support for international students.

Aligning the use of portfolios with digital badging

While the place of portfolios in medical training is established, there are limits to their use. This article discusses the potential use of digital badges to complement portfolios, as these provide a transparent overview of a learners level of competence.

MOOCs and SMOCs: changing the face of medical education?

Dear Sir, The revolutionary forces at play in medical education are full steam ahead. From PBL, TBL and the flipped classroom, which has barely had time to cement itself we might add, we are now faced with the prospect of massive open online courses (MOOCs) and synchronous massive online courses (SMOCs). MOOCs or massive open online courses are still fairly premature in the field of medicine with limited courses currently available. Examples in present use include Introductory Human Physiology by Coursera and Fundamentals of Clinical Trials courtesy of edX. From a learning perspective we can only hypothesize the potential benefits of such a movement. For instance, students may gain an enhanced understanding of pathology not common to their resident country or gain further understanding of hard to grasp concepts by clinicians renowned in their field of expertise. Whilst medical schools are not currently offering academic credits for MOOC courses, the American Council on Education has certified four Coursera courses [1] so that students can gain credits recognized by institutes of higher education. At the same time Coursera has announced that MOOC courses can count for continuing medical education [1]. However, just like the flipped classroom, the dust has been barely left to settle following the arrival of MOOCs as a result of the recently announced SMOCs which may hold greater promise [2]. Gosling and Pennebaker, both psychology professors at the University of Texas in Austin, coined the term when they delivered their lectures live to enrolled students. Gosling’s interest is based on his stated downside of MOOCs being the lack of intimacy, community and simultaneous experience. From our perspective, such a concept could no doubt enhance medical learning in real time, adding to the concept of learning from live patient consultations and procedural intervention, which is currently a rare occurrence. Whatever the future holds for medical education, it is sure to continue to amaze many an instructor and we for one feel it should be embraced wholeheartedly.

Increasing child and adolescent mental health content in undergraduate occupational therapy, social work and nursing programs: Lessons learnt.

Abstract This paper investigates the perceived usefulness of a CD-Rom based child and adolescent mental health teaching resource distributed to educators from undergraduate nursing, occupational therapy and social work programs, and identifies the barriers to incorporating specialist mental health content into comprehensive degree level courses. Specially selected educators from throughout New Zealand responded to a questionnaire about the resource. Results from their feedback indicate that the resource was generally well received and that it was perceived to be useful for teaching at an undergraduate level. However, three main issues appear to be hindering the up-take of the resource in the relevant undergraduate programs: the resource content did not readily integrate into the various existing courses; several practical and additional barriers impeded the up-take and use of the resource; and incorporating a self-directed multi-media based teaching resource into a range of existing degree level programs that used a face-to-face group-based teaching model was perceived to be problematic. Recommendations are offered to assist in overcoming these difficulties in order to increase the extent of child and adolescent mental health teaching delivered at an undergraduate level.