Evaluation of an online learning tool to improve medical students' clinical reasoning skills

Background: Evidence suggests that problems in clinical reasoning skills – the thought processes required to make clinical decisions – are the leading cause of diagnostic errors, which can lead to significant patient harm. Theories of learning and clinical reasoning have indicated online patient simulations (OPS) could be a novel approach to improving medical students’ clinical reasoning skills. However, little is known about their impact on clinical reasoning. Methods: I conducted a systematic literature review to explore the effectiveness of OPS. Informed by my review and theory, I co-developed eCREST (electronic Clinical Reasoning Skills Educational Simulation Tool). I assessed the feasibility, acceptability and potential impact of eCREST at three UK medical schools with a feasibility randomised controlled trial (RCT). I explored how students reasoned when using eCREST and what factors influenced reasoning, using a Think Aloud and interview approach with 16 medical students. Results: My systematic review found OPS may be effective at improving medical students’ clinical reasoning skills but the few studies available lacked methodological rigour, so these results should be treated with caution. Uptake and retention in the feasibility trial was acceptable and provided evidence to support a definitive RCT. Impact data suggested eCREST may improve clinical reasoning skills - the intervention group were significantly more likely to gather essential information from the ‘patient’ than controls (OR = 1.4; 95% CI 1.1-1.7, n = 148). Qualitative findings suggested that students use a variety of data gathering strategies and eCREST helped students to structure their data gathering and stay open-minded about diagnosis. Students’ knowledge, confidence and engagement with eCREST also influenced these strategies. Conclusions: Tools like eCREST can improve reasoning skills by helping students to gather essential information and potentially reduce future missed diagnostic opportunities. Evaluations of such tools are now needed within medical curricula, using validated outcome measures to determine effectiveness

The Longitudinal Impact of Social Media Use on UK Adolescents' Mental Health: Longitudinal Observational Study

BACKGROUND: Cross-sectional studies have found a relationship between social media use and depression and anxiety in young people. However, few longitudinal studies using representative data and mediation analysis have been conducted to understand the causal pathways of this relationship. OBJECTIVE: This study aims to examine the longitudinal relationship between social media use and young people's mental health and the role of self-esteem and social connectedness as potential mediators. METHODS: The sample included 3228 participants who were 10- to 15-year-olds from Understanding Society (2009-2019), a UK longitudinal household survey. The number of hours spent on social media was measured on a 5-point scale from "none" to "7 or more hours" at the ages of 12-13 years. Self-esteem and social connectedness (number of friends and happiness with friendships) were measured at the ages of 13-14 years. Mental health problems measured by the Strengths and Difficulties Questionnaire were assessed at the ages of 14-15 years. Covariates included demographic and household variables. Unadjusted and adjusted multilevel linear regression models were used to estimate the association between social media use and mental health. We used path analysis with structural equation modeling to investigate the mediation pathways. RESULTS: In adjusted analysis, there was a nonsignificant linear trend showing that more time spent on social media was related to poorer mental health 2 years later (n=2603, β=.21, 95% CI 0.43 to 0.84; P=.52). In an unadjusted path analysis, 68% of the effect of social media use on mental health was mediated by self-esteem (indirect effect, n=2569, β=.70, 95% CI 0.15-1.30; P=.02). This effect was attenuated in the adjusted analysis, and it was found that self-esteem was no longer a significant mediator (indirect effect, n=2316, β=.24, 95% CI 0.12 to 0.66; P=.22). We did not find evidence that the association between social media and mental health was mediated by social connectedness. Similar results were found in imputed data. CONCLUSIONS: There was little evidence to suggest that more time spent on social media was associated with later mental health problems in UK adolescents. This study shows the importance of longitudinal studies to examine this relationship and suggests that prevention strategies and interventions to improve mental health associated with social media use could consider the role of factors like self-esteem

The Impact of Social Media Use Interventions on Mental Well-Being: Systematic Review

BACKGROUND: There is some evidence that more social media use is related to poorer mental well-being and that social media use can become problematic when it starts to interfere with a person's daily life and mental well-being. To address this issue and improve users' mental well-being, social media use interventions (eg, abstinence from social media) have been developed and evaluated. However, there is limited understanding of the effectiveness of these interventions in improving mental well-being. OBJECTIVE: This systematic review aimed to synthesize the literature on the effectiveness of social media use interventions in improving mental well-being in adults. METHODS: A systematic search (January 1, 2004, to July 31, 2022) was completed across 3 databases in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Experimental studies evaluating the impact of social media use interventions on mental well-being in adults were included. Outcomes related to mental well-being, such as depression, anxiety, stress, and loneliness, were included. A narrative synthesis without meta-analysis was completed to summarize the study characteristics and effectiveness by outcome and intervention type. The Effective Public Health Practice Project Quality Assessment Tool was used to measure the quality of the studies. RESULTS: Of the 2785 studies identified through the systematic search, 23 (0.83%) were included in the analysis. Many of the included studies (9/23, 39%) found improvements in mental well-being, some (7/23, 30%) found mixed effects, and others (7/23, 30%) found no effect on mental well-being. Therapy-based interventions that used techniques such as cognitive behavioral therapy were more effective than limiting use of social media or full abstinence from social media, with 83% (5/6) of these studies showing improvements in mental well-being compared with 20% (1/5) and 25% (3/12), respectively. Depression was the most frequently investigated and improved outcome with 70% (7/10) of the studies showing a significant improvement in depression after the intervention, whereas other outcomes showed more varied results. Quality was poor, with 96% (22/23) of the studies receiving a weak global score, mostly for issues related to selection bias because most of the studies (16/23, 70%) used a convenience sampling of university students. CONCLUSIONS: This review provides some evidence that social media use interventions are effective in improving mental well-being, especially for depression and when using therapy-based interventions. Further experimental and longitudinal research is needed with representative samples to investigate who may benefit most from social media use interventions. This will help to develop guidance and recommendations for policy makers and clinicians on how best to manage problematic social media use

The longitudinal effect of social media use on adolescent mental health in the UK: findings from the UK Longitudinal Household Study

BACKGROUND: Cross-sectional studies have suggested an association between the use of social media and depression and anxiety in young people. We examined the longitudinal relationship between social media use and young people's mental health, and the role of self-esteem and social connectedness as potential mediators. METHODS: Adolescents (aged 10-15 years) from the UK Longitudinal Household Study (2009-19) were included. Mental health was measured by the Strengths and Difficulties Questionnaire Total Difficulties score. The number of hours spent on social media was measured on a 5-point scale, from zero to ≥7 h. Self-esteem and social connectedness were measured at ages 13-14 years. Covariates included demographic and household variables. Unadjusted and adjusted multilevel linear regression models explored whether social media use at ages 12-13 years predicted mental health at ages 14-15 years (expressed as beta values and 95% CIs). Path analysis with structural equation modelling was used to investigate the mediation pathways. FINDINGS: We included 3228 adolescents (1659 [51·4%] girls and 1569 [48·6%] boys) for whom social media and mental health data at ages 12-13 years and 14-15 years were available. In adjusted analysis, no association between time spent on social media and poorer mental health was identified (n=2603; b=0·21 [95% CI -0·43 to 0·84]; p=0·52). In adjusted path analysis, there was no mediation of self-esteem (indirect effect; n=2316; b=0·24 [95% CI -0·12 to 0·66]; p=0·22) or social connectedness (indirect effect; -0·03 [-0·20 to 0·12]; p=0·74), but in unadjusted analysis, 68% of the effect of social media use on mental health was mediated by self-esteem (indirect effect; n=2569; 0·70 [0·15 to 1·30]; p=0.016) but not by social connectedness. Similar results were found when the analysis was re-run on a multiply imputed dataset that filled in missing values using multiple imputation. INTERPRETATION: Our data show the importance of longitudinal evidence. We found there was little evidence to suggest a causal relationship between the use of social media and mental health issues 2 years later. Interventions that address social media use alone might not improve young people's mental health, and considering factors such as self-esteem might be more effective. FUNDING: UK National Institute for Health Research School for Public Health Research (grant reference PD-SPH-2015). The views expressed are those of the authors and not necessarily those of the National Institute for Health Research or the UK Department of Health and Social Care

The effectiveness of using virtual patient educational tools to improve medical students’ clinical reasoning skills: a systematic review

Background: Use of virtual patient educational tools could fll the current gap in the teaching of clinical reasoning skills. However, there is a limited understanding of their efectiveness. The aim of this study was to synthesise the evidence to understand the efectiveness of virtual patient tools aimed at improving undergraduate medical students’ clinical reasoning skills. Methods: We searched MEDLINE, EMBASE, CINAHL, ERIC, Scopus, Web of Science and PsycINFO from 1990 to January 2022, to identify all experimental articles testing the efectiveness of virtual patient educational tools on medical students’ clinical reasoning skills. Quality of the articles was assessed using an adapted form of the MERSQI and the Newcastle–Ottawa Scale. A narrative synthesis summarised intervention features, how virtual patient tools were evaluated and reported efectiveness. Results: The search revealed 8,186 articles, with 19 articles meeting the inclusion criteria. Average study quality was moderate (M=6.5, SD=2.7), with nearly half not reporting any measurement of validity or reliability for their clinical reasoning outcome measure (8/19, 42%). Eleven articles found a positive efect of virtual patient tools on reasoning (11/19, 58%). Four reported no signifcant efect and four reported mixed efects (4/19, 21%). Several domains of clinical reasoning were evaluated. Data gathering, ideas about diagnosis and patient management were more often found to improve after virtual patient use (34/47 analyses, 72%) than application of knowledge, fexibility in thinking and problem-solving (3/7 analyses, 43%). Conclusions: Using virtual patient tools could efectively complement current teaching especially if opportunities for face-to-face teaching or other methods are limited, as there was some evidence that virtual patient educational tools can improve undergraduate medical students’ clinical reasoning skills. Evaluations that measured more case specifc clinical reasoning domains, such as data gathering, showed more consistent improvement than general measures like problem-solving. Case specifc measures might be more sensitive to change given the context dependent nature of clinical reasoning. Consistent use of validated clinical reasoning measures is needed to enable a metaanalysis to estimate efectiveness

Professionals’ views on the use of smartphone technology to support children and adolescents with memory impairment due to acquired brain injury

Purpose: To identify from a health-care professionals’ perspective whether smartphones are used by children and adolescents with acquired brain injury as memory aids; what factors predict smartphone use and what barriers prevent the use of smartphones as memory aids by children and adolescents. Method: A cross-sectional online survey was undertaken with 88 health-care professionals working with children and adolescents with brain injury. Results: Children and adolescents with brain injury were reported to use smartphones as memory aids by 75% of professionals. However, only 42% of professionals helped their clients to use smartphones. The only factor that significantly predicted reported smartphone use was the professionals’ positive attitudes toward assistive technology. Several barriers to using smartphones as memory aids were identified, including the poor accessibility of devices and cost of devices. Conclusion: Many children and adolescents with brain injury are already using smartphones as memory aids but this is often not facilitated by professionals. Improving the attitudes of professionals toward using smartphones as assistive technology could help to increase smartphone use in rehabilitation

Adolescent Experiences of the COVID-19 Pandemic and School Closures and Implications for Mental Health, Peer Relationships and Learning: A Qualitative Study in South-West England

The COVID-19 ‘lockdown’ and multiple school closures disrupted the daily lives and routines of the entire UK population. However, adolescents were likely particularly impacted by such measures due to this time being key for social and educational development. This qualitative study explored young people’s experiences of lockdowns and school closures. Fifteen secondary schools within south-west England were initially contacted and three schools participated in recruitment efforts. From December 2020 to March 2021, 25 students aged 14–15 participated in a combination of individual interviews (n = 5) and focus groups (n = 3). Findings revealed diverse experiences of the pandemic and highlighted the complexity of experiences according to individual student contexts. Three main themes were identified: (1) Learning environments; (2) Connection to peers; (3) Transition, adaptation and coping. These findings highlight the value young people place on face-to-face social contact with close friends, and the sense of structure provided by school, with implications for future home-based learning. Further in-depth qualitative research is needed to continue to understand the varied experiences during the course of the pandemic, particularly longer-term impacts on mental health and learning

Impact of School and Peer Connectedness on Adolescent Mental Health and Well-Being Outcomes during the COVID-19 Pandemic: A Longitudinal Panel Survey

School closures and social distancing measures during the pandemic have disrupted young people’s daily routines and social relationships. We explored patterns of change in adolescent mental health and tested the relationship between pre-pandemic levels of school and peer connectedness and changes in mental health and well-being between the first lockdown and the return to school. This is a secondary analysis of a longitudinal 3-wave panel survey. The study sample included 603 students (aged 13–14) in 17 secondary schools across south-west England. Students completed a survey pre-pandemic (October 2019), during lockdown (May 2020) and shortly after returning to school (October 2020). Multilevel models, with random effects, were conducted for anxiety, depression and well-being outcomes with school and peer connectedness as predictor variables. Symptoms of anxiety decreased from pre-pandemic to during the first UK lockdown and increased on the return to school; anxious symptoms decreased the most for students reporting feeling least connected to school pre-pandemic. Students reporting low levels of school and peer connectedness pre-pandemic experienced poorer mental health and well-being at all time points. Low school connectedness pre-pandemic was associated with a greater increase in anxious and depressive symptoms between lockdown and the return to school when compared to students with medium levels of school connectedness. No associations were found with high school connectedness or with low/high peer connectedness. For adolescents with poor school connectedness, the enforced time away from school that the pandemic caused led to reduced anxiety. Going forwards, we need to consider ways in which to promote connection with school as a way of supporting mental health and well-being

Adolescent Experiences of the COVID-19 Pandemic and School Closures and Implications for Mental Health, Peer Relationships and Learning: A Qualitative Study in South-West England

The COVID-19 ‘lockdown’ and multiple school closures disrupted the daily lives and routines of the entire UK population. However, adolescents were likely particularly impacted by such measures due to this time being key for social and educational development. This qualitative study explored young people’s experiences of lockdowns and school closures. Fifteen secondary schools within south-west England were initially contacted and three schools participated in recruitment efforts. From December 2020 to March 2021, 25 students aged 14–15 participated in a combination of individual interviews (n = 5) and focus groups (n = 3). Findings revealed diverse experiences of the pandemic and highlighted the complexity of experiences according to individual student contexts. Three main themes were identified: (1) Learning environments; (2) Connection to peers; (3) Transition, adaptation and coping. These findings highlight the value young people place on face-to-face social contact with close friends, and the sense of structure provided by school, with implications for future home-based learning. Further in-depth qualitative research is needed to continue to understand the varied experiences during the course of the pandemic, particularly longer-term impacts on mental health and learning

Impact of School and Peer Connectedness on Adolescent Mental Health and Well-Being Outcomes during the COVID-19 Pandemic:A Longitudinal Panel Survey

School closures and social distancing measures during the pandemic have disrupted young people’s daily routines and social relationships. We explored patterns of change in adolescent mental health and tested the relationship between pre-pandemic levels of school and peer connectedness and changes in mental health and well-being between the first lockdown and the return to school. This is a secondary analysis of a longitudinal 3-wave panel survey. The study sample included 603 students (aged 13–14) in 17 secondary schools across south-west England. Students completed a survey pre-pandemic (October 2019), during lockdown (May 2020) and shortly after returning to school (October 2020). Multilevel models, with random effects, were conducted for anxiety, depression and well-being outcomes with school and peer connectedness as predictor variables. Symptoms of anxiety decreased from pre-pandemic to during the first UK lockdown and increased on the return to school; anxious symptoms decreased the most for students reporting feeling least connected to school pre-pandemic. Students reporting low levels of school and peer connectedness pre-pandemic experienced poorer mental health and well-being at all time points. Low school connectedness pre-pandemic was associated with a greater increase in anxious and depressive symptoms between lockdown and the return to school when compared to students with medium levels of school connectedness. No associations were found with high school connectedness or with low/high peer connectedness. For adolescents with poor school connectedness, the enforced time away from school that the pandemic caused led to reduced anxiety. Going forwards, we need to consider ways in which to promote connection with school as a way of supporting mental health and well-being