More than surgical tools: a systematic review of robots as didactic tools for the education of professionals in health sciences

Utilising artificial intelligence in developing education of health sciences higher education: An umbrella review of reviews

OBJECTIVE

This umbrella review of reviews aims to synthesise current evidence on AI's utilisation in developing education within health sciences disciplines.

DESIGN

An umbrella review of reviews, review of reviews, based on Joanna Briggs Institute guidelines.

DATA SELECTION

CINAHL, ERIC(ProQuest), PubMed, Scopus, and Medic were systematically searched in December 2023 with no time limit. The inclusion and exclusion criteria were defined according to the PCC framework: Participants(P), Concept(C), and Context (C). Two independent researchers screened 6304 publications, and 201 reviews were selected in the full-text phase.

DATA EXTRACTION

All the reviews that met inclusion criteria were included in the analysis. The reference lists of included reviews were also searched. Included reviews were quality appraised. The results were analysed with narrative synthesis.

RESULTS OF DATA SYNTHESIS

Seven reviews published between 2019 and 2023 were selected for analysis. Five key domains were identified: robotics, machine learning and deep learning, big data, immersive technologies, and natural language processing. Robotics enhances practical medical, dental and nursing education training. Machine learning personalises learning experiences and improves diagnostic skills. Immersive technologies provide interactive simulations for practical training.

CONCLUSION

This umbrella review of reviews highlights the potential of AI in health sciences education and the need for continued investment in AI technologies and ethical frameworks to ensure effective and equitable integration into educational practices.

Evaluating the Instructional Strategies Influencing Self-Regulated Learning in Clinical Clerkship Years: A Mixed Studies Review

Self-regulated learning (SRL) can significantly improve academic achievement and clinical performance. The clinical clerkship is a crucial setting for reinforcing and extending SRL skills and behaviors into clinical practice. However, learning in clinical settings is often opportunistic and contextual, requiring diverse instructional strategies and tailored learning opportunities. Studies from the past two decades have indicated challenges in implementing SRL strategies particularly in Asian countries. While many of the pedagogical approaches used in medical education include aspects of SRL theory, a comprehensive overview of effective SRL instructional strategies in clinical clerkships is lacking. We reviewed all studies (published between January 2012 and May 2024, identified via systematic search of EBSCOhost, PubMed, ScienceDirect, Scopus, and Web of Science) that discuss instructional strategies influencing SRL among clinical clerkship students, in general, and with special reference to the Asian context. Twenty seven articles were included in the final analysis. We conducted convergent integrated synthesis on the data extracted from all included studies to generate categories and themes. SRL instructional strategies reported included implementing learning plans and goal setting, operationalizing formal mentoring and feedback processes, utilizing technology-enhanced learning, facilitating collaborative group learning, providing simulation-based learning experiences, and applying experiential learning strategies. When implemented effectively, such strategies were shown to promote self-regulated learning, motivational beliefs, self-monitoring, and self-reflection. Faculty support, mentoring and timely feedback were crucial in successfully implementing SRL strategies. Incorporating SRL into existing curricula was ideal for ensuring feasibility and long-term sustainability. Limited research from the Asian region indicates that SRL has not been used to its full potential in Asian medical education. Asian medical students' SRL potential could be maximized with shared roles of students and teachers in a student-driven approach. Medical educators should take responsibility for providing opportunities and a conducive environment to foster SRL among clinical clerkship students. Future research should prioritize longitudinal, experimental studies with comparison groups and objective SRL outcome measures to rigorously evaluate the impact of instructional strategies in the clinical clerkship context.

Assessing the Effectiveness of Interactive Robot-Assisted Virtual Health Coaching for Health Literacy and Disease Knowledge of Patients with Chronic Kidney Disease: Quasiexperimental Study

BACKGROUND

Chronic kidney disease (CKD) imposes a significant global health and economic burden, impacting millions globally. Despite its high prevalence, public awareness and understanding of CKD remain limited, leading to delayed diagnosis and suboptimal management. Traditional patient education methods, such as 1-on-1 verbal instruction or printed brochures, are often insufficient, especially considering the shortage of nursing staff. Technology-assisted education presents a promising and standardized solution, emphasizing the need for innovative and scalable approaches to improve CKD-specific knowledge and health literacy.

OBJECTIVE

This study aimed to develop and evaluate the effectiveness of an innovative 12-unit virtual health coaching program delivered through interactive robots that is intended to enhance disease knowledge and health literacy among patients with CKD.

METHODS

A quasiexperimental design was used, and 60 participants were evenly assigned to experimental and comparison groups. However, due to attrition, 14 participants in the experimental group and 16 participants in the comparison group completed the study. The intervention involved a 12-unit program, with each unit lasting approximately 20 minutes to 30 minutes and delivered across 3 to 4 learning sessions, and participants completed 3 to 4 units per session. The program addressed key aspects of CKD-specific health literacy including functional, communicative, and critical literacy and CKD-specific knowledge including basic knowledge, prevention, lifestyle, dietary intake, and medication. Data were collected through validated pre and postintervention questionnaires. All 30 participants completed the program and subsequent evaluations, with outcome measures assessing changes in CKD-specific knowledge and health literacy.

RESULTS

Postintervention analysis using generalized estimating equations, adjusted for age, revealed that the experimental group (n=14) had significantly greater improvements in health literacy (coefficient=2.51, Wald χ²1=5.89; P=.02) and disease knowledge (coefficient=1.66, Wald χ²1=11.75; P=.001) than the comparison group (n=16). Postintervention t tests revealed significant improvements in CKD-specific health literacy and disease knowledge (P<.001) between the experimental and comparison groups. Additional analyses identified significant group × time interactions, indicating improvements in communicative literacy (P=.01) and critical literacy (P=.02), while no significant changes were observed in functional literacy. Regarding disease knowledge, the experimental group demonstrated a significant improvement in medication (P<.001), whereas changes in basic knowledge, prevention, lifestyle, and dietary intake were not significant.

CONCLUSIONS

This study demonstrated that interactive robot-assisted eHealth coaching effectively enhanced CKD-specific disease knowledge and health literacy. Despite the challenges posed by the COVID-19 pandemic, which constrained sample sizes, the findings indicate that this program is a promising patient education tool in clinical nephrology. Future research should involve larger sample sizes to enhance generalizability and examine additional factors influencing effectiveness.

Humanoid patient robot for diagnostic training in medical and psychiatric education

Simulation-based learning is an integral part of hands-on learning and is often done through role-playing games or patients simulated by professional actors. In this article, we present the use of a humanoid robot as a simulation patient for the presentation of disease symptoms in the setting of medical education. In a study, 12 participants watched both the patient simulation by the robotic patient and the video with the actor patient. We asked participants about their subjective impressions of the robotic patient simulation compared to the video with the human actor patient using a self-developed questionnaire. In addition, we used the Affinity for Technology Interaction Scale. The evaluation of the questionnaire provided insights into whether the robot was able to realistically represent the patient which features still need to be improved, and whether the robot patient simulation was accepted by the participants as a learning method. Sixty-seven percent of the participants indicated that they would use the robot as a training opportunity in addition to the videos with acting patients. The majority of participants indicated that they found it very beneficial to have the robot repeat the case studies at their own pace.

Assessment of the evolution of psychomotor skills in the robotic surgery simulation process

Robotic surgery is a rapidly expanding field, given the wide variety of new robotic platforms emerging. Looking at the training of surgeons in robotic surgery is of extreme necessity and urgency, considering the ongoing technological advancements. In this research, the performance during the virtual reality simulation phase of training for robotic surgery was analyzed. It was observed that, in addition to the lack of consensus among societies regarding the required simulation hours, there is no guidance on the best curriculum to be adopted. From the data in this study, it can be inferred that the more advanced skills have fewer proficient individuals, meaning that fewer surgeons in training have reached proficiency in all skill exercises. Even with differences in the number of exercises performed proficiently between groups that underwent varying amounts of simulation time, there is no statistically significant difference in the proportion between them.

Questionnaire survey on hands-on simulation training using a dental humanoid robot (SIMROID®)

INTRODUCTION

A dental humanoid robot, SIMROID®, is able to replicate the actions characteristic of human beings and enable training for communicating with patients and coping with unexpected situations. This study assessed user experiences via a survey questionnaire following hands-on training on the SIMROID®.

MATERIALS AND METHODS

A total of 112 participants, consisting of 50 high school students who visited AUSD (Asahi University School of Dentistry) to participate in open campus events, 42 fourth-year students at AUSD and 20 dental students from Mexico State Autonomy University, University of Siena and Peking University took the survey. The participants observed the movements and reactions of a SIMROID® robot placed on a dental unit for approximately 20 min after which they completed a questionnaire survey. Both Japanese and English versions of the questionnaire were prepared for local and visiting foreign dental students. The questionnaire comprised 8 items, with a further two items for those undertaking dental training and an open comment field.

RESULTS

All participants who observed the SIMROID® completed the questionnaire giving a 100% response rate. Generally, simulation training with SIMROID® was highly appreciated by all participants. The comprehensive evaluation score for SIMROID® was 4.56 ± 0.50 points for high school students, 4.05 ± 0.82 points for students at AUSD and 4.70 ± 0.47 points for foreign dental students, showing all participants had a very positive experience and impression of the SIMROID®.

CONCLUSIONS

Therefore, simulation training using SIMROID® seems beneficial learning tool.

Establishment and implementation of a clinical application and research database for surgical robots in China

Robots are widely used in surgeries worldwide. To improve robotic surgical treatments, we established a database of clinical applications and research on surgical robots. Robotics‐related literature included in the China national knowledge infrastructure (CNKI), Wanfang, Vipshop, Chinese science citation database (CSCD), Web of Science, EMBASE, PubMed, and Cochrane databases up to September 2022 was searched and entered into the database. Information on all patients who had undergone robotic surgery at our hospital since 2016 was also included. Literature and case information was classified and evaluated according to standard guidelines and statements. The Gansu Provincial Hospital was the first to use evidence‐based medical research methods to successfully establish a database of clinical applications and research on surgical robots. This database comprised literature search, upload, quality evaluation, risk of bias assessment, case information entry, and access functions. Based on the database, we conducted related studies in general surgery, gynecology, urology, thoracic surgery, and cardiovascular surgery, and published 16 meta‐analyses and 15 clinical studies. Establishing this database removes language, retrieval, and evaluation barriers in clinicians' use of clinical evidence and lays the foundation for the efficient and accurate use of clinical data for future research. Further, it facilitates evidence‐based evaluation of the effectiveness of robotic therapy, which may guide future medical practice. This typical case of interdisciplinary research aims to build a platform to disseminate knowledge and technology in robotic surgery.

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Precision public health, the key for future outbreak management: A scoping review

Background

Precision Public Health (PPH) is a newly emerging field in public health medicine. The application of various types of data allows PPH to deliver more tailored interventions to a specific population within a specific timeframe. However, the application of PPH possesses several challenges and limitations that need to be addressed.

Objective

We aim to provide evidence of the various use of PPH in outbreak management, the types of data that could be used in PPH application, and the limitations and barriers in the application of the PPH approach.

Methods and analysis

Articles were searched in PubMed, Web of Science, and Science Direct. Our selection of articles was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for Scoping Review guidelines. The outcome of the evidence assessment was presented in narrative format instead of quantitative.

Results

A total of 27 articles were included in the scoping review. Most of the articles (74.1%) focused on PPH applications in performing disease surveillance and signal detection. Furthermore, the data type mostly used in the studies was surveillance (51.9%), environment (44.4), and Internet query data. Most of the articles emphasized data quality and availability (81.5%) as the main barriers in PPH applications followed by data integration and interoperability (29.6%).

Conclusions

PPH applications in outbreak management utilize a wide range of data sources and analytical techniques to enhance disease surveillance, investigation, modeling, and prediction. By leveraging these tools and approaches, PPH contributes to more effective and efficient outbreak management, ultimately reducing the burden of infectious diseases on populations. The limitation and challenges in the application of PPH approaches in outbreak management emphasize the need to strengthen the surveillance systems, promote data sharing and collaboration among relevant stakeholders, and standardize data collection methods while upholding privacy and ethical principles.

Low-cost simulator for intra-abdominal bleeding

BACKGROUND

training in critical surgical situations is crucial for a safe outcome. The use of simulators is well established, although many are quite expensive, requiring the search for financially viable solutions for training centers.

METHODS

we built a low-cost simulator for intra-abdominal bleeding with inexpensive materials, such as a manikin chest, latex tubes, silicone rubber, and waterproof fabric, seeking to mimic the abdominal viscera and vessels and their anatomical correlations. An IV infusion set allowed simulated blood to flow under pressure, and the blood flowed freely during simulation. After obtaining a functional model, we selected general surgeons to validate the simulator and its use in teaching surgery. We used the content validity index (CVI), with a cutoff of 0.9.

RESULTS

the cost of building the prototype was US$71,00 in 2021, accounting for the purchase of the various necessary materials. Twelve raters participated in the validation tests. The results obtained from the feedback survey showed a good evaluation of all items, especially the recognition of the injured vessel, access to the vascular injury, hemostasis by manual compression, and hemostatic suturing.

CONCLUSION

the proposed simulator obtained good results in scenarios of intra-abdominal bleeding from large vessels, as well as for hemostasis by manual compression and suturing. It proved to be a useful tool for training in critical intra- abdominal bleeding situations, while maintaining a low cost of building.

Health science staff and student experiences of teaching and assessing clinical skills using digital tools: a qualitative study

INTRODUCTION

Once considered a supplement to traditional teaching approaches, digital tools now play a pivotal role in building core clinical competencies. This study aims to explore staff and student experiences of navigating the challenges of teaching and assessing clinical skills using digital technology. It also aims to provide insight into what skills, or aspects of skills, may be best suited to digitally enhanced teaching, thereby advancing the future of health science education.

METHODS

This qualitative study comprises the second phase of data generation for a mixed-methods research project entitled DEPTH (Digitally Enhanced Practical Teaching in Health Science). Health science staff and students expressed interest in taking part in the current study during the first stage of data collection. Qualitative data was collected in January 2022 through semi-structured group interviews and individual semi-structured interviews. An interpretivist qualitative research design underpinned by a critical realist epistemological position was used. Themes were generated following Braun and Clarke's 6-step process for reflexive thematic analysis.

RESULTS

Overall, 10 staff and 8 students across 11 health science disciplines participated in this research. Fourteen hours of transcripts were analysed and 4 themes generated. Our findings highlight the suitability of digitally enhanced teaching for low-stake skills requiring visual and auditory training, while skills requiring tactile training require in-person practice to build student competency. Importantly, our findings indicate a desire for increased remote teaching. While our work was not specifically aimed at documenting experiences related to the Covid-19 pandemic, all participants had lived experience teaching or learning during the pandemic and many spoke specifically about this.

CONCLUSIONS

The timing of this paper captures a novel moment in the history of clinical pedagogy. Staff and students advocate for the continued integration of technology into health science education generally, and clinical skills teaching specifically. For this to be successful, judicious selection of methods, skills, skill components and technology, that can be appropriately mapped onto specific learning outcomes, is required.

Modeling, Control, and Clinical Validation of an Upper-Limb Medical Education Task Trainer for Elbow Spasticity and Rigidity Assessment

The goal of this study was to validate a series elastic actuator (SEA)-based robotic arm that can mimic three abnormal muscle behaviors, namely lead-pipe rigidity, cogwheel rigidity, and spasticity for medical education training purposes. Key characteristics of each muscle behavior were first modeled mathematically based on clinically-observed data across severity levels. A controller that incorporated feedback, feedforward, and disturbance observer schemes was implemented to deliver haptic target muscle resistive torques to the trainee during passive stretch assessments of the robotic arm. A series of benchtop tests across all behaviors and severity levels were conducted to validate the torque estimation accuracy of the custom SEA (RMSE: ~ 0.16 Nm) and the torque tracking performance of the controller (torque error percentage: < 2.8 %). A clinical validation study was performed with seven experienced clinicians to collect feedback on the task trainer's simulation realism via a Classification Test and a Disclosed Test. In the Classification Test, subjects were able to classify different muscle behaviors with a mean accuracy > 87 % and could further distinguish severity level within each behavior satisfactorily. In the Disclosed Test, subjects generally agreed with the simulation realism and provided suggestions on haptic behaviors for future iterations. Overall, subjects scored 4.9 out of 5 for the potential usefulness of this device as a medical education tool for students to learn spasticity and rigidity assessment.

The Promotion of Healthy Hydration Habits through Educational Robotics in University Students

In recent years, there has been a lack of healthy lifestyle habits in the population, including hydration, with negative consequences for health. At the same time, advances in technology have changed the process of teaching and learning since elementary school, highlighting the incorporation of educational robots as innovative resources in recent years. This study analyzes the state of the scientific knowledge presented by university students doing a university degree in Primary Education after a robotics-based educational intervention. The study adopted a quasi-experimental design with a qualitative approach, using category systems and a quantitative approach with descriptive and inferential (Chi-square and Contingency Coefficient) statistics. The results of the study show that the level of scientific knowledge has improved in the different scientific contents involved, highlighting the excellent level presented for the recommended daily volume of hydration. Innovative interventions, through digital resources such as Educational Robotics, are presented as possible alternatives to promoting the healthy habit of hydration, due the effective learning of biosanitary knowledge in the young population.