The reCAPTCHA of medical education.

This article focuses on what Luis von Ahn called the "twofer," that is, a single solution that elegantly addresses two problems on a large scale. We describe two of von Ahn's creations: reCAPTCHA, which validates a human web presence while also digitizing hard-to-read words, and Duolingo, which teaches new languages while translating the web. We then consider how this approach can be applied to medical education. Embedding Wikipedia-editing into educational settings is one such solution that could both improve the quality of health information available to the public while enhancing the learning of future health professionals.

Crowdsourcing for assessment items to support adaptive learning.

PURPOSE: Adaptive learning requires frequent and valid assessments for learners to track progress against their goals. This study determined if multiple-choice questions (MCQs) "crowdsourced" from medical learners could meet the standards of many large-scale testing programs. METHODS: Users of a medical education app (Osmosis.org, Baltimore, MD) volunteered to submit case-based MCQs. Eleven volunteers were selected to submit MCQs targeted to second year medical students. Two hundred MCQs were subjected to duplicate review by a panel of internal medicine faculty who rated each item for relevance, content accuracy, and quality of response option explanations. A sample of 121 items was pretested on clinical subject exams completed by a national sample of U.S. medical students. RESULTS: Seventy-eight percent of the 200 MCQs met faculty reviewer standards based on relevance, accuracy, and quality of explanations. Of the 121 pretested MCQs, 50% met acceptable statistical criteria. The most common reasons for exclusion were that the item was too easy or had a low discrimination index. CONCLUSIONS: Crowdsourcing can efficiently yield high-quality assessment items that meet rigorous judgmental and statistical criteria. Similar models may be adopted by students and educators to augment item pools that support adaptive learning.

Using "big data" to guide implementation of a web and mobile adaptive learning platform for medical students.

BACKGROUND: Adaptive learning platforms (ALPs) can revolutionize medical education by making learning more efficient, but their potential has not been realized because students do not use them persistently. METHODS: We applied educational data mining methods to study United States medical students who used an ALP called Osmosis ( www.osmosis.org ) from 1 August 2014 to 31 July 2015. Multivariate logistic regressions modeled persistence on Osmosis as the dependent variable and Osmosis-collected variables as predictors. RESULTS: The 6787 students included in our analysis responded to a total of 887,193 items, with 2138 (31.5%) using Osmosis persistently. Number of items per student, mobile device use, subscription payment, and group membership were independently associated with persisting (p < 0.001 in all models). Persistent users rated quality more favorably (p < 0.01) but were not more confident in answer selections (p = 0.80). While persisters were more accurate than non-persisters (55% (SD 18%) vs 52% (SD 22%), p < 0.001), after adjusting for number of items, lower accuracy was associated with persistent use (OR 0.93 [95% CI 0.90-0.97], p < 0.01). CONCLUSIONS: Our study of a large sample of U.S. medical students illustrates big data medical education research and provides guidance for improving implementation of ALPs and further investigation.

The genetic control of neocortex volume and covariation with neocortical gene expression in mice.

BACKGROUND: The size of the cerebral cortex varies widely within human populations, and a large portion of this variance is modulated by genetic factors. The discovery and characterization of these genes and their variants can contribute to an understanding of individual differences in brain development, behavior, and disease susceptibility. Here we use unbiased stereological techniques to map quantitative trait loci (QTLs) that modulate the volume of neocortex. RESULTS: We estimated volumes bilaterally in an expanded set of BXD recombinant inbred strains (n = 56 strains and 223 animals) taken from the Mouse Brain Library http://www.mbl.org. We generated matched microarray data for the cerebral cortex in the same large panel of strains and in parental neonates to efficiently nominate and evaluate candidate genes. Volume of the neocortex varies widely, and is a heritable trait. Genome-wide mapping of this trait revealed two QTLs--one on chromosome (Chr) 6 at 88 +/- 5 Mb and another at Chr 11 (41 +/- 8 Mb). We generated both neonatal and adult neocortical gene expression databases using microarray technology. Using these databases in combination with other bioinformatic tools we have identified positional candidates on these QTL intervals. CONCLUSION: This study is the first to use the expanded set of BXD strains to map neocortical volume, and we found that normal variation of this trait is, at least in part, genetically modulated. These results provide a baseline from which to assess the genetic contribution to regional variation in neocortical volume, as well as other neuroanatomic phenotypes that may contribute to variation in regional volume, such as proliferation, death, and number and packing density of neurons.

Medical Education Videos for the World: An Analysis of Viewing Patterns for a YouTube Channel.

PURPOSE: Medical education videos can enhance learning and easily integrate into common instructional methods. YouTube permits worldwide access to high-quality medical education videos; however, no studies have described the reach of medical education videos on YouTube or what topics are preferred. METHOD: One year of YouTube analytics data (February 1, 2016, to January 31, 2017) was collected for a medical-education-focused channel called Osmosis. Created December 20, 2015, the channel had 189 disease-focused videos by January 2017. Viewer and subscriber data were analyzed according to the World Bank's four income and seven region classifications. Topic viewing was analyzed according to income level. RESULTS: The channel had accumulated 105,117 subscribers and 5,226,405 views for 20,153,093 minutes (38.3 years) from viewers located in 213/218 (97.7%) World Bank economies. While the number of videos increased 4.8-fold from February 2016 to January 2017, monthly views increased 50-fold and subscribers increased 117-fold. Low- or middle-income countries generated 2.2 million (42%) views and 52,942 (50%) subscribers, with similar view proportions across income level during the 12 months. A plurality of views (1.5 million; 29%) came from North America; Sub-Saharan Africa had the lowest number (150,065; 2.9%). Topic viewing generally corresponded to population health statistics. CONCLUSIONS: Medical education content on YouTube can immediately and consistently reach a global viewership with relevant content. Educators may consider posting videos to YouTube to reach a broad audience. Future work should seek to optimize assessment of learning and investigate how videos may affect patients.

Using Commercial Activity Monitors to Measure Gait in Patients with Suspected iNPH: Implications for Ambulatory Monitoring.

OBJECTIVES: This study seeks to validate the use of activity monitors to detect and record gait abnormalities, potentially identifying patients with idiopathic normal pressure hydrocephalus (iNPH) prior to the onset of cognitive or urinary symptoms. METHODS: This study compared the step counts of four common activity monitors (Omron Step Counter HJ-113, New Lifestyles 2000, Nike Fuelband, and Fitbit Ultra) to an observed step count in 17 patients with confirmed iNPH. RESULTS: Of the four devices, the Fitbit Ultra (Fitbit, Inc., San Francisco, CA) provided the most accurate step count. The correlation with the observed step count was significantly higher (p<0.009) for the Fitbit Ultra than for any of the other three devices. CONCLUSIONS: These preliminary findings suggest that existing activity monitors have variable efficacy in the iNPH patient population and that the MEMS tri-axial accelerometer and algorithm of the Fitbit Ultra provides the most accurate gait measurements of the four devices tested.

iMedEd: the role of mobile health technologies in medical education.

Mobile health (mHealth) technologies have experienced a recent surge in attention because of their potential to transform the delivery of health care. This enthusiasm is partly due to the near ubiquity of smartphones and tablets among clinicians, as well as to the stream of mobile medical apps and devices being created. While much discussion has been devoted to how these tools will impact the practice of medicine, surprisingly little has been written on the role these technologies will play in medical education. In this commentary the authors describe the opportunities, applications, and challenges of mHealth apps and devices in medical education and argue that medical schools should make efforts to integrate these technologies into their curricula. By not doing so, medical educators risk producing a generation of clinicians underprepared for the changing realities of medical practice brought on by mHealth technologies.