Nonpharmacologic Pain Management Among Hospitalized Inpatients: A Randomized Waitlist-Controlled Trial of Standard Virtual Reality (CGI VR) Versus Video Capture VR (360 degrees 3D/Stereoscopic Video Capture VR).

OBJECTIVES: Nonpharmacologic pain management strategies are needed because of the growing opioid epidemic. While studies have examined the efficacy of virtual reality (VR) for pain reduction, there is little research in adult inpatient settings, and no studies comparing the relative efficacy of standard animated computer-generated imagery (CGI) VR to Video Capture VR (360 degrees 3D/stereoscopic Video Capture VR). Here, we report on a randomized controlled trial of the relative efficacy of standard CGI VR versus Video Capture VR (matched for content) and also compared the overall efficacy of VR to a waitlist control group. MATERIALS AND METHODS: Participants (N=103 hospitalized inpatients reporting pain) were randomized to 1 of 3 conditions: (1) waitlist control, (2) CGI VR, or (3) Video Capture VR. The VR and waitlist conditions were 10 minutes in length. Outcomes were assessed pretreatment, post-treatment, and after a brief follow-up. RESULTS: Consistent with hypotheses, both VR conditions reduced pain significantly more relative to the waitlist control condition (d=1.60, P<0.001) and pain reductions were largely maintained at the brief follow-up assessment. Both VR conditions reduced pain by ∼50% and led to improvements in mood, anxiety, and relaxation. Contrary to prediction, the Video Capture VR condition was not significantly more effective at reducing pain relative to the CGI VR condition (d=0.25, P=0.216). However, as expected, patients randomized to the Video Capture VR rated their experience as more positive and realistic (d=0.78, P=0.002). DISCUSSION: Video Capture VR was as effective as CGI VR for pain reduction and was rated as more realistic.

Using Interactive Learning Modules to Teach Value-Based Health Care to Health Professions Trainees Across the United States.

PROBLEM: Despite prominent calls to incorporate value-based health care (VBHC) into medical education, there is still a global need for robust programs to teach VBHC concepts throughout health professions training. APPROACH: In June 2017, Dell Medical School released the first collection (three modules) of a set of free interactive online learning modules, which aim to teach the basic foundations of VBHC to health professions learners at any stage of training and can be incorporated across diverse educational settings. These modules were designed by an interprofessional team based on principles of cognitive engagement for active learning. OUTCOMES: From June 2017 to September 2018, the website received 130,098 pageviews from 8,546 unique users (2,072 registered users), representing 45 states in the United States and 10 foreign countries. As of October 15, 2018, 568 (27%) of registered users completed modules 1-3. Five-hundred thirty-five of these users completed a survey (94% response rate). Nearly all (484/535; 90%) reported overall satisfaction with the curriculum, 522/535 (98%) agreed "after completing the modules, I can define value in health care," and 520/535 (97%) agreed "after completing the modules, I can provide examples of low- and high-value care." Second-year Dell Medical School students reported that they have incorporated value into their clinical clerkships (e.g., by discussing VBHC with peers [43/45; 96%]) as a result of completing the modules. NEXT STEPS: Future plans for the curriculum include the release of additional modules, more robust knowledge assessment, and an expanded learning platform that allows for further community engagement.

A university system's approach to enhancing the educational mission of health science schools and institutions: the University of Texas Academy of Health Science Education.

BACKGROUND: The academy movement developed in the United States as an important approach to enhance the educational mission and facilitate the recognition and work of educators at medical schools and health science institutions. OBJECTIVES: Academies initially formed at individual medical schools. Educators and leaders in The University of Texas System (the UT System, UTS) recognized the academy movement as a means both to address special challenges and pursue opportunities for advancing the educational mission of academic health sciences institutions. METHODS: The UTS academy process was started by the appointment of a Chancellor's Health Fellow for Education in 2004. Subsequently, the University of Texas Academy of Health Science Education (UTAHSE) was formed by bringing together esteemed faculty educators from the six UTS health science institutions. RESULTS: Currently, the UTAHSE has 132 voting members who were selected through a rigorous, system-wide peer review and who represent multiple professional backgrounds and all six campuses. With support from the UTS, the UTAHSE has developed and sustained an annual Innovations in Health Science Education conference, a small grants program and an Innovations in Health Science Education Award, among other UTS health science educational activities. The UTAHSE represents one university system's innovative approach to enhancing its educational mission through multi- and interdisciplinary as well as inter-institutional collaboration. CONCLUSIONS: The UTAHSE is presented as a model for the development of other consortia-type academies that could involve several components of a university system or coalitions of several institutions.

Otitis media in children: use of diagnostic tools by family practice residents.

BACKGROUND AND OBJECTIVES: Although otitis media is a common problem in primary care, little is known about the use of diagnostic tools such as pneumatic otoscopy, tympanometry, acoustic reflectometry, or tympanocentesis by family physicians in training. METHODS: This was a self-reported observational study of family practice residents' use of otitis media diagnostic tools. Twenty-three family practice programs in Texas and Oklahoma were surveyed during November and December 2000. Residents were asked about their use of diagnostic tools, and, if tools were not used, they were asked the reason for not using them. Residents were also asked about the criteria they used to diagnose otitis media, and their responses were compared to criteria recommended by national guideline panels. RESULTS: The response rate was 61% (n = 316). The percentage of residents using pneumatic otoscopy was 66%, tympanometry 29%, acoustic reflectometry 2%, and tympanocentesis 0%. The most common reasons cited for not using tools were lack of training or unavailability of equipment. Fifty-five percent of family practice residents do not report pneumatic otoscopy for diagnosing otitis media and thus did not use recommended criteria. Faculty training of residents in the use of diagnostic tools was associated with a higher rate of using these tools. DISCUSSION: Few residents believed that diagnostic tools had no value in the diagnosis of otitis media, but lack of training or equipment problems were reported as contributing to their not using these tools. Half of family practice residents may be inadequately diagnosing middle ear problems since they did not report that pneumatic otoscopy was necessary for diagnosing otitis media. Because training was associated with higher rates of using appropriate diagnostic tools, family medicine faculty can play a significant role in improving the residents' diagnostic skills.