Twelve tips on creating and using custom GPTs to enhance health professions education.

The custom GPT is the latest powerful feature added to ChatGPT. Non-programmers can create and share their own GPTs ("chat bots"), allowing Health Professions Educators to apply the capabilities of ChatGPT to create administrative assistants, online tutors, virtual patients, and more, to support their clinical and non-clinical teaching environments. To achieve this correctly, however, requires some skills, and this 12-Tips paper provides those: we explain how to construct data sources, build relevant GPTs, and apply some basic security.

Online learning in Health Professions Education. Part 1: Teaching and learning in online environments: AMEE Guide No. 161.

Online learning in Health Professions Education (HPE) has been evolving over decades, but COVID-19 changed its use abruptly. Technology allowed necessary HPE during COVID-19, but also demonstrated that many HP educators and learners had little knowledge and experience of these complex sociotechnical environments. Due to the educational benefits and flexibility that technology can afford, many higher education experts agree that online learning will continue and evolve long after COVID-19. As HP educators stand at the crossroads of technology integration, it is important that we examine the evidence, theories, advantages/disadvantages, and pedagogically informed design of online learning. This Guide will provide foundational concepts and practical strategies to support HPE educators and institutions toward advancing pedagogically informed use of online HPE. This Guide consists of two parts. The first part will provide an overview of evidence, theories, formats, and educational design in online learning, including contemporary issues and considerations such as learner engagement, faculty development, inclusivity, accessibility, copyright, and privacy. The second part (to be published as a separate Guide) focuses on specific technology tool types with practical examples for implementation and integration of the concepts discussed in Guide 1, and will include digital scholarship, learning analytics, and emerging technologies. In sum, both guides should be read together, as Guide 1 provides the foundation required for the practical application of technology showcased in Guide 2.Please refer to the video abstract for Part 1 of this Guide at https://bit.ly/AMEEGuideOnlineLearning.

Online learning in health professions education. Part 2: Tools and practical application: AMEE Guide No. 163.

Part 1 of the AMEE Guide Online learning in health professions education focused on foundational concepts such as theory, methods, and instructional design in online learning. Part 2 builds upon Part 1, introducing technology tools and applications of these foundational concepts by exploring the various levels (from beginner to advanced) of utilisation, while describing how their usage can transform Health Professions Education. This Part covers Learning Management Systems, infographics, podcasting, videos, websites, social media, online discussion forums, simulation, virtual patients, extended and virtual reality. Intertwined are other topics, such as online small group teaching, game-based learning, FOAM, online social and collaboration learning, and virtual care teaching. We end by discussing digital scholarship and emerging technologies. Combined with Part 1, the overall aim of Part 2 is to produce a comprehensive overview to help guide effective use online learning in Health Professions Education.

Big Assumptions in Online and Blended Continuing Professional Development: Finding Our Way Forward Together.

ABSTRACT: Continuing professional development (CPD) providers and faculty face a practice gap between our knowledge of effective practices in CPD and our implementation of them, particularly in online environments. Developmental psychologists Bob Kegan and Lisa Lahey have attributed such knowledge-implementation gaps to an "Immunity to Change" rooted in tacit "Big Assumptions." These Big Assumptions produce fears or worries, reveal competing commitments, and result in actions or inactions that hinder intended change. We sought to understand the barriers to change in online and blended CPD, to support CPD leaders in pursuing their goals for optimal use of technology in CPD. This inquiry arose from the 13th National Continuing Professional Development Accreditation Conference of the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada, a virtual conference held in October 2022. After introducing the Immunity to Change framework and best practices in online and blended learning, we invited audience members to list Big Assumptions in CPD through chat and polling software. These responses were analyzed and grouped into five interrelated Big Assumptions that suggest a number of key barriers to optimal implementation of online CPD. We present data that counter each Big Assumption along with practical approaches to facilitate desired change for CPD.

Perceived Advantages and Disadvantages of Online Continuing Professional Development (CPD) During COVID-19: CPD Providers' Perspectives.

INTRODUCTION: COVID-19 precipitated many CPD providers to develop new technology competencies to create effective online CPD. This study aims to improve our understanding of CPD providers' comfort level, supports, perceived advantages/disadvantages, and issues in technology-enhanced CPD delivery during COVID-19. METHODS: A survey was distributed to CPD providers at the University of Toronto and members of the Society for Academic Continuing Medical Education and analyzed using descriptive statistics. RESULTS: Of the 111 respondents, 81% felt very to somewhat confident to provide online CPD, but less than half reported IT, financial, or faculty development supports. The top reported advantage to online CPD delivery was reaching a new demographic; top disadvantages included videoconferencing fatigue, social isolation, and competing priorities. There was interest in using less frequently used educational technology such as online collaboration tools, virtual patients, and augmented/virtual reality. DISCUSSION: COVID-19 precipitated an increased comfort level in using synchronous technologies to provide CPD, giving the CPD community an increased cultural acceptance and skill level to build on. As we move beyond the pandemic, it will be important to consider ongoing faculty development, particularly toward asynchronous and HyFlex delivery methods to continue expand CPD reach and negate negative online experiences such as videoconferencing fatigue, social isolation, and online distractions.

Effect of mobile application types on stroke rehabilitation: a systematic review.

BACKGROUND: Stroke is a significant contributor of worldwide disability and morbidity with substantial economic consequences. Rehabilitation is a vital component of stroke recovery, but inpatient stroke rehabilitation programs can struggle to meet the recommended hours of therapy per day outlined by the Canadian Stroke Best Practices and American Heart Association. Mobile applications (apps) are an emerging technology which may help bridge this deficit, however this area is understudied. The purpose of this study is to review the effect of mobile apps for stroke rehabilitation on stroke impairments and functional outcomes. Specifically, this paper will delve into the impact of varying mobile app types on stroke rehabilitation. METHODS: This systematic review included 29 studies: 11 randomized control trials and 18 quasi-experimental studies. Data extrapolation mapped 5 mobile app types (therapy apps, education apps, rehab videos, reminders, and a combination of rehab videos with reminders) to stroke deficits (motor paresis, aphasia, neglect), adherence to exercise, activities of daily living (ADLs), quality of life, secondary stroke prevention, and depression and anxiety. RESULTS: There were multiple studies supporting the use of therapy apps for motor paresis or aphasia, rehab videos for exercise adherence, and reminders for exercise adherence. For permutations involving other app types with stroke deficits or functional outcomes (adherence to exercise, ADLs, quality of life, secondary stroke prevention, depression and anxiety), the results were either non-significant or limited by a paucity of studies. CONCLUSION: Mobile apps demonstrate potential to assist with stroke recovery and augment face to face rehabilitation, however, development of a mobile app should be carefully planned when targeting specific stroke deficits or functional outcomes. This study found that mobile app types which mimicked principles of effective face-to-face therapy (massed practice, task-specific practice, goal-oriented practice, multisensory stimulation, rhythmic cueing, feedback, social interaction, and constraint-induced therapy) and education (interactivity, feedback, repetition, practice exercises, social learning) had the greatest benefits. Protocol registration PROPSERO (ID CRD42021186534). Registered 21 February 2021.

Treatment of hiccups in stroke rehabilitation with gabapentin: A case series and focused clinical review.

BACKGROUND: Persistent and intractable hiccups have a major impact on quality of life and can be a barrier to stroke rehabilitation. The first-line treatment for intractable hiccups, chlorpromazine, can have sedating effects, which may negatively affect rehabilitation participation. Gabapentin has been reported in several cases to be effective in hiccup treatment in both the general and post-stroke populations. OBJECTIVE: To describe the use of gabapentin for treatment of persistent or intractable hiccups in post-stroke patients. METHODS: Four cases were identified by clinicians for a retrospective review. A literature review was concurrently conducted. RESULTS: This case series presents four patients with improvement or resolution of intractable hiccups on gabapentin in a stroke rehabilitation setting. Therapeutic dose ranged from 100 mg TID to 400 mg BID. Treatment duration ranged from 2 days to 5.5 weeks. Adjuncts were used in three of the cases. A potential side effect was worsened confusion in one case. CONCLUSION: Evidence on the use of gabapentin for persistent or intractable hiccups is limited. This case series expands on the current literature by examining and comparing the current literature to our cases and exploring issues related to dosing, titration, side effects, and adjuncts to gabapentin.

Quantifying the Occurrence of Shoulder Pain after Cardiac Surgery in a Cardiac Rehabilitation Population.

Purpose: The aim of this study was to identify the occurrence of shoulder pain after cardiac surgery among cardiac rehabilitation participants (CRPs) and its interaction with cardiac rehabilitation (CR). Method: This was a cross-sectional questionnaire-based study of open-heart surgery patients conducted at the midpoint of a 6-month CR programme. We measured the proportion of patients experiencing shoulder pain, onset, location, impact on rehabilitation, and pain and disability using the Shoulder Pain and Disability Index. Results: Of 70 (76% men) CRPs, 47% (33) reported shoulder pain post-surgery, with most (91%; 29 of 32) remaining symptomatic at the time of questionnaire completion, 14.6 (SD 37.9) months post-surgery. Disability and pain scores were 4.2 (SD 2.8) and 5.7 (SD 2.5), respectively (maximum score 10). Of people with shoulder pain participating in resistance training (RT; 19), 8 (42%) reported it was beneficial for shoulder pain; 7 (37%), no effect or unknown; and 4 (21%), some aggravation. Modifications to RT by programme staff were reported by 47% (8) of participants. Of those with shoulder pain, 10 (31%) reported some benefit; 20 (63%), no effect or unknown; and 2 (6%), aggravation from aerobic training. Conclusions: Almost half of the CRPs who had undergone open-heart surgery reported moderately severe and disabling shoulder pain that persisted for at least 14.6 (SD 37.9) months. Almost half the RT participants were prescribed exercise modifications with few negative effects. Shoulder pain is a significant issue after surgery, and appropriate screening is recommended for safe CR participation.

Objectif : établir l'occurrence de douleur à l'épaule après une chirurgie cardiaque chez des patients en réadaptation cardiaque (PRC) et en déterminer l'interaction avec la réadaptation cardiaque (RC). Méthodologie : étude transversale par questionnaire auprès de patients ayant subi une opération à cœur ouvert qui se trouvaient à mi-parcours d'un programme de RC de six mois. Les chercheurs ont mesuré la proportion de patients ressentant des douleurs à l'épaule, l'apparition de la douleur, son siège, ses répercussions sur la réadaptation, de même que la douleur et l'incapacité d'après le score de douleur à l'épaule et d'incapacité. Résultats : chez les 70 PRC (76 % d'hommes), 47 % (33) ont déclaré ressentir une douleur à l'épaule après l'opération, et la plupart (91 %; 29 sur 32) étaient encore symptomatiques au moment de remplir le questionnaire, 14,6 mois (ÉT 37,9) plus tard. Les scores d'incapacité et de douleur s'établissaient à 4,2 (ÉT 2,8) et 5,7 (ÉT 2,5), respectivement (score maximal de 10). Chez les personnes ressentant une douleur à l'épaule qui ont participé à un entraînement en résistance (ER; 19), huit (42 %) ont déclaré ce type d'entraînement bénéfique, sept (37 %) ont trouvé qu'il n'avait aucun effet ou que cet effet était inconnu et seulement quatre (21 %) ont constaté une certaine aggravation. De plus, 47 % des participants (8) ont indiqué que le personnel du programme avait modifié l'ER. Chez ceux qui ressentaient une douleur à l'épaule, dix (31 %) ont déclaré que l'entraînement aérobique procurait certains avantages, 20 (63 %) ont trouvé qu'il n'avait aucun effet ou que cet effet était inconnu et seulement deux (6 %) ont signalé une aggravation. Conclusion : près de la moitié des PRC qui ont subi une opération à cœur ouvert ont déclaré une douleur à l'épaule modérément grave et incapacitante qui a persisté au moins 14,6 mois (ÉT 37,9). Près de la moitié des participants à un ER se sont fait prescrire des modifications aux exercices et en ont ressenti peu d'effets négatifs. La douleur à l'épaule est un problème important après l'opération. Un dépistage approprié est recommandé pour assurer une participation à la RC en toute sécurité.

All for one and one for all: understanding health professionals' experience in individual versus collaborative online learning.

INTRODUCTION: Computer-supported collaborative learning (CSCL) may facilitate continuing interprofessional education while overcoming barriers of time and place for busy health care professionals. The purpose of this study was to understand the experiences, advantages, and challenges of group versus individual online learning. METHODS: Fifteen multidisciplinary health professionals participated in a 12-week online course on either diabetes or traumatic brain injury. This consisted of background e-modules and a longitudinal build-a-case exercise, done either individually or as a group. Focus group sessions exploring participants' experiences after course completion and at 4 months were conducted, transcribed, and analyzed for recurring themes. Participant reflection homework and video-recorded group sessions were used for triangulation of results. RESULTS: Individual learners appreciated the flexibility and control, but experienced decreased motivation. Group learners appreciated the immediate feedback from their co-learners and felt social pressure to come to the weekly sessions prepared but expressed challenges in determining group goal-setting for the session. Both groups felt they learned about interprofessional roles; however, group learners described a richer learning experience and understanding of interprofessional roles through the online collaboration exercise. The intense resources necessary for interprofessional CSCL, including time, faculty development, and technological issues, are described. DISCUSSION: CSCL is a valuable educational strategy in online learning. While individual online learning may be better suited for short and simple educational interventions such as knowledge acquisition, CSCL seems to allow for richer and deeper learning in complex and interprofessional educational experiences. However, strategies, resources, and faculty development required to enhance CSCL need to be addressed carefully.

Examination of cardiac rehabilitation participants referred to a musculoskeletal clinic.

PURPOSE: To describe participants in a cardiac rehabilitation program who were referred to an in-house musculoskeletal clinic and their cardiac rehabilitation and musculoskeletal outcomes. METHODS: A retrospective chart review was done on 51 participants who were referred to the musculoskeletal clinic between February 1, 2009, and March 31, 2010. Data on demographics, clinical characteristics, and cardiac rehabilitation and musculoskeletal outcomes were collected. Analyses included descriptive statistics and nonparametric analysis of outcome measures. RESULTS: Of the 51 participants, 88.2% reported preexisting musculoskeletal conditions. The most common region of diagnosed musculoskeletal conditions included knee(s) (45.1%), back (25.5%), and shoulder(s) (17.6%). For those who attended the musculoskeletal clinic and had pre-/postintervention data (n = 14), there was a significant improvement from initial to final mean Numerical Pain Rating Scale scores (P = .001) and peak oxygen uptake measures (P = .002). CONCLUSION: A musculoskeletal clinic within a cardiac rehabilitation program could allow for musculoskeletal conditions to be addressed in an effective manner and potentially minimize their negative impact on cardiac rehabilitation participation and outcomes.

Flying blind: the experience of online interprofessional facilitation.

The role of the facilitator is known to be important in fostering productive interprofessional education (IPE) in the face-to-face (F2F) environment. Online learning can help surmount some of the logistical challenges in IPE by bringing together diverse professionals in multiple geographical locations. Best practices in F2F IPE facilitation are beginning to emerge, but there is scant literature examining IPE facilitation online. What little research exists has focused on the asynchronous environment and suggests that the skill sets of online and F2F facilitators have considerable overlap, but there are further demands in the online setting. This qualitative study sought to examine online synchronous IPE facilitation through the self-reported experiences of seven trained facilitators during a 12-week online course. Data collected through focus groups and targeted interviews were analyzed by the research team using constant comparison techniques. Four major themes were revealed: technology as a dynamic force, reduction in non-verbal cues, evolution of the online IPE group process over time and the importance of co-facilitation. The foundations of IPE facilitation were seen to carry over to the online setting. This study has implications for the training of IPE facilitators and for the design of online IPE learning experiences.