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Background Delirium occurs frequently in older hospitalised patients and is associated with several adverse outcomes. Ignorance among healthcare professionals and a failure to recognise patients suffering from delirium have been identified as the possible causes of poor care. The objective of the study was to determine whether e-learning can be an effective means of improving implementation of a quality improvement project in delirium care. This project aims primarily at improving the early recognition of older patients who are at risk of delirium. Methods In a stepped wedge cluster randomised trial an e-learning course on delirium was introduced, aimed at nursing staff. The trial was conducted on general medical and surgical wards from 18 Dutch hospitals. The primary outcome measure was the delirium risk screening conducted by nursing staff, measured through monthly patient record reviews. Patient records from patients aged 70 and over admitted onto wards participating in the study were used for data collection. Data was also collected on the level of delirium knowledge of these wards’ nursing staff. Results Records from 1,862 older patients were included during the control phase and from 1,411 patients during the intervention phase. The e-learning course on delirium had a significant positive effect on the risk screening of older patients by nursing staff (OR 1.8, p-value <0.01), as well as on other aspects of delirium care. The number of patients diagnosed with delirium was reduced from 11.2% in the control phase to 8.7% in the intervention phase (p = 0.04). The e-learning course also showed a significant positive effect on nurses’ knowledge of delirium. Conclusions Nurses who undertook a delirium e-learning course showed a greater adherence to the quality improvement project in delirium care. This improved the recognition of patients at risk and demonstrated that e-learning can be a valuable instrument for hospitals when implementing improvements in delirium care. Trial registration The Netherlands National Trial Register (NTR). Trial number: NTR2885 .

Background Completion of Advance Directives (ADs), being financial and healthcare proxy or instructional documents, is relatively uncommon in Australia. Efforts to increase completion rates include online education and prompting which past literature suggests may be effective. The aim of this randomized controlled trial was to assess computer-based online AD information and email prompting for facilitating completion of ADs by Australian Baby Boomers (b.1946–1965) as well as factors which may impede or assist completion of these documents by this generation when using the online environment. Methods Two hundred eighty-two men and women aged 49–68 years at the time of the trial were randomly assigned to one of 3 intervention groups: education module only; email prompt only; email prompt and education module; and a control group with no education module and no email prompt. The randomized controlled trial was undertaken in participants’ location of choice. Randomization and allocation to trial group were carried out by a central computer system. The primary analysis was based on a final total of 189 participants who completed the trial ( n  = 52 education module only; n  = 44 email prompt only; n  = 46 email prompt and education module; and n  = 47 control). The primary outcome was the number of individuals in any group completing any of the 4 legal ADs in South Australia within 12 months or less from entry into the trial. Frequency analysis was conducted on secondary outcomes such as reasons for non-completion. Results Mean follow-up post-intervention at 12 months showed that 7% of overall participants completed one or more of the 4 legal ADs but without significant difference between groups (delta = 1%, p  = .48 Prompt/Non-Prompt groups, delta = 5%, p  = .44 education/non-education groups). Reasons offered for non-completion were too busy (26%) and/or it wasn’t the right time (21%). Conclusion Our results suggest that neither email prompting nor provision of additional educational material online were sufficient to significantly impact AD completion rates for this generational cohort. Research with this cohort over longer periods of time exploring online preferences for engagement with ADs as they age may provide better insight into using this environment for ADs with this group. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12616000425493 .

“If students are going to miss half of what usually constitutes the student experience, are they really receiving the same value for money?” Furthermore, online learning is no substitute for laboratory work. [...]recessions diminish the prospects for graduate employment. “Without any action, universities will be forced to make huge cuts, jobs will be lost, and vital research will be halted”, a spokesperson for Universities UK, an umbrella group representing 137 institutions, told The Lancet Oncology. “Pretty much every university in the country is looking at voluntary redundancies”, added Malcolm Reed (Dean of Brighton and Sussex Medical School, Brighton, UK, and Co-Chair of the Medical Schools Council, London, UK).

The COVID-19-pandemic forced many countries to close schools abruptly in the spring of 2020. These school closures and the subsequent period of distance learning has led to concerns about increasing inequality in education, as children from lower-educated and poorer families have less access to (additional) resources at home. This study analyzes differences in declines in learning gains in primary education in the Netherlands for reading, spelling and math, using rich data on standardized test scores and register data on student and parental background for almost 300,000 unique students. The results show large inequalities in the learning loss based on parental education and parental income, on top of already existing inequalities. The results call for a national focus on interventions specifically targeting vulnerable students.

The last 25 years have seen enormous progression in digital technologies across the whole of the health service, including health education. The rapid evolution and use of web-based and digital techniques have been significantly transforming this field since the beginning of the new millennium. These advancements continue to progress swiftly, even more so after the COVID-19 pandemic. This narrative review aims to outline and discuss the developments that have taken place in digital medical education across the defined time frame. In addition, evidence for potential opportunities and challenges facing digital medical education in the near future was collated for analysis. Literature reviews were conducted using PubMed, Web of Science Core Collection, Scopus, Google Scholar, and Embase. The participants and learners in this study included medical students, physicians in training or continuing professional development, nurses, paramedics, and patients. Evidence of the significant steps in the development of digital medical education in the past 25 years was presented and analyzed in terms of application, impact, and implications for the future. The results were grouped into the following themes for discussion: learning management systems; telemedicine (in digital medical education); mobile health; big data analytics; the metaverse, augmented reality, and virtual reality; the COVID-19 pandemic; artificial intelligence; and ethics and cybersecurity. Major changes and developments in digital medical education have occurred from around the start of the new millennium. Key steps in this journey include technical developments in teleconferencing and learning management systems, along with a marked increase in mobile device use for accessing learning over this time. While the pace of evolution in digital medical education accelerated during the COVID-19 pandemic, further rapid progress has continued since the resolution of the pandemic. Many of these changes are currently being widely used in health education and other fields, such as augmented reality, virtual reality, and artificial intelligence, providing significant future potential. The opportunities these technologies offer must be balanced against the associated challenges in areas such as cybersecurity, the integrity of web-based assessments, ethics, and issues of digital privacy to ensure that digital medical education continues to thrive in the future.

How virtual classrooms and dire finances could alter academia: part 1 in a series on science after the pandemic. How virtual classrooms and dire finances could alter academia: part 1 in a series on science after the pandemic.

The sudden switch to distance education to contain the outbreak of the COVID-19 pandemic has fundamentally altered adolescents’ lives around the globe. The present research aims to identify psychological characteristics that relate to adolescents’ well-being in terms of positive emotion and intrinsic learning motivation, and key characteristics of their learning behavior in a situation of unplanned, involuntary distance education. Following Self-Determination Theory, experienced competence, autonomy, and relatedness were assumed to relate to active learning behavior (i.e., engagement and persistence), and negatively relate to passive learning behavior (i.e., procrastination), mediated via positive emotion and intrinsic learning motivation. Data were collected via online questionnaires in altogether eight countries from Europe, Asia, and North America (N = 25,305) and comparable results across countries were expected. Experienced competence was consistently found to relate to positive emotion and intrinsic learning motivation, and, in turn, active learning behavior in terms of engagement and persistence. The study results further highlight the role of perceived relatedness for positive emotion. The high proportions of explained variance speak in favor of taking these central results into account when designing distance education in times of COVID-19.

[...]many institutes will have supplemented recordings with shorter, live question and answer styled sessions to confirm understanding, address any confusion and possibly of most importance, to see their students, check on well-being and simply talk to them. The disadvantages varied from place to place, but included: being unable to confirm the student’s attendance, difficulties in achieving active engagement of students, internet connectivity issues, deliberate or inadvertent disturbances i.e. unnecessary voices and annotations over the display screen, and there were a few students who were deprived of the education resource materials. Attempts have also been made to inculcate photographs of pathological features found during autopsy; radiographs to discuss forensic anthropology and age estimation; videos on forensic taphonomy; links illustrating mechanical injuries; recent news articles reporting medicolegal cases etc. for the purpose to gain knowledge over discussion with ethical considerations at all the stages. Institutional support was also extended to support increased subscription to various e-learning modules, e-books, e-library access, additional international journals, etc. to provide the students with multiple new learning modalities in their homes.

With the emergence of the COVID-19 pandemic, universities immediately responded to protect students' lives by implementing e-learning in order to stop the spread of the communicable disease within the academic population. This study aimed to describe iranian nursing students' experiences of e-learning during the COVID-19 pandemic. The current study used a qualitative descriptive study. Ten nursing undergraduate students from a single Iranian university identified using purposive sampling methods. Face-to-face semi-structured interview conducted from May to July 2021 and analyzed through thematic analysis. Lincoln and Goba criteria were used to obtain data validity and reliability. Four themes emerged including\"novelty of e-learning\",\"advantages of e-learning\", \"disadvantages of e-learning\"and\"passage of time and the desire to return to face education\". Participants evaluated e-learning as a novel method without proper infrastructure, it was initially confusing but became the new normal as their knowledge of the way to use it improved. Advantages included self-centered flexible learning and reduction in their concerns experienced with face-to-face learning. Disadvantages including changing the way they interact with teachers, decreasing interactions with classmates, problems with education files, superficial learning, hardware problems, family members' perceptions of the student role, interference of home affairs with e-learning, cheating on exams and assignments and being far away from the clinical context. The findings revealed that e-learning has been introduced as a new method for the current research participants and despite the perceived benefits, these students believed that e-learning could supplement face education but not replace it.

Since the declaration of COVID-19 as a pandemic, all scientific medical activities were shifted to an online format, in the form of webinars, to maintain continuing medical education (CME). We aimed to assess physicians' attitude among different medical specialties towards this sudden and unexpected shift of traditional face-to-face meetings into webinars, and to suggest future recommendations. We conducted a cross-sectional, internet-based survey study using a 25-item questionnaire, from November 1 and November 15, 2020. The survey was created and distributed to physicians from different medical and surgical specialties and from different countries via several social media platforms, using a snowball technique. A total of 326 physicians responded; 165 (50.6%) were females, mean age of responders was 38.7 ± 7.5 years. The majority of responses (93.2%) came from Arab countries. Of them, 195 (59.8%) reported attending more webinars compared to the same period last year, with average of 3 per month. As regard to the general impression; 244 (74.8%) were \"strongly satisfied\" or \"satisfied\", with the most satisfaction for \"training courses: by 268 (82.2%), and \"International conferences\" by 218 (66.9%). However, 246 respondents (75.5%) felt overwhelmed with the number and frequency of webinars during the pandemic, 171 (52.5%) reported attending less than 25% of webinars they are invited to, 205 (62.8%) disagreed that webinars can replace in-person meetings after the pandemic, and 239 (73.3%) agreed that online meetings need proper regulations. Webinars comprised a major avenue for education during COVID-19 pandemic, with initial general satisfaction among physicians. However, this paradigm shift was sudden and lacked proper regulations. Despite initial satisfaction, the majority of physicians felt overwhelmed with the number and frequency of webinars. Physicians' satisfaction is crucial in planning future educational activities, and considering that this current crisis will most likely have long lasting effects, webinars should be viewed as complementing traditional in-person methods, rather than replacement. In this study, we are suggesting recommendations to help future regulation of this change.