Over the past decade, medical education has undergone vast changes to keep up with progressing technology.1-5 At multiple locations, tele-educational courses haverevolutionized the way we look at education today.6-9 The global online community has become more accessible with the development of tablets, smartphones, and improved internet capabilities. Recently, the penetration of internet facilities and the number of users have shown an exponential increase in both developed and developing countries.10,11 This has augured well for a sustained growth of tele-education options. Tele-education for developed countries offers a different approach to the already-available education systems. On the other hand, in developing nations, the lack of an organized training infrastructure and facilities is a stark reality. In that setting tele-education can dramatically impact both the quality and quantity of education that can be imparted to trainees. More importantly, this can be achieved without any significant increase of resources and without straining the already insufficient manpower.12,13 Although textbooks are generally available freely around the world, the correct interpretation of clinical concepts from the books in a convenient and reproducible manner often requires astute teaching by an experienced clinician-teacher. In the underdeveloped and developing world, the availability of such a teaching task force is usually inadequate. This leaves a large gap between the studied theories and the applicable practice. With the constant bombardment of information from all over the world via internet and social media, the attention span of the populace is also ever decreasing. Thus, for any educational modality to be effective, it is imperative that it catches the attention of the end-user and dissipates the intended information in a short time span. The L V Prasad Eye Institute (LVPEI) in southern India developed a novel mode of tele-education, called a Just-A-Minute (JAM) clinical pearls, which aimed at providing clinical concepts in a concise format. The format readily caters to the reduced attention span of the reader, and at the same time providing to-the-point clinical concepts that can be readily applied to the clinic.
The JAM pearls are small units of clinical concepts drawn from the vast experience of the clinical faculty of LVPEI. They are clinical caveats not necessarily proven in textbooks but are based on many years of patient care experience. Multiple clinical pearls were collected from the clinical faculty and each pearl was presented on a single slide. A typical pearl consisted of a short description of the clinical concept, a relevant clinical photograph, and the identity of the concerned clinical faculty member. One such slide was sent as an email blast daily in the morning to all ophthalmologists in the email database of LVPEI.
After sending 365 pearls during September 2016 to August 2017, the project was halted for a review. A survey was then conducted among recipients of the JAM clinical pearls to assess its uptake and evaluate its impact on their clinical practice.
MATERIALS AND METHODS
An online questionnaire was sent to all the recipients of JAM clinical pearls by email to gauge their feedback on the project (Appendix 1). The aim of the survey was to understand the acceptability and uptake of the pearls, to ascertain which specific subspecialty was the recipients most interested in, and to use the collected data for future planning of the project (eg, a second phase of JAM pearls).
The data were entered into an Excel spreadsheet. Relevant statistical analysis was done using MedCalc version 18. The mean and standard deviations were computed for all continuous variables. In case of nonparametric distributions, the median was calculated.
An online questionnaire was sent to a total of 14,311 JAM pearls recipients by email, and 719 (5%) responded to the survey. Most of the recipients were in India (66.5%) followed by the United States (26.4%), United Kingdom (1.0%), Canada (0.9%), and Singapore (0.6%). Among the respondents, over half (52.9%) were postgraduate ophthalmologists in general practice and 38.3% were post-fellowship subspecialty practitioners (Fig. 1). Among those in practice, the mean (± standard deviation) time in practice was 14.6 ± 10.9 years (median, 12 years). Private practitioners constituted 57.3% of all respondents and 42.7% were in institutional academic practice.
Over 88% of recipients “always” or “very regularly” accessed the pearls (Fig. 2). The subspecialties most sought after were cornea and anterior segment (48.7%) followed by vitreoretina (28.1%) (Fig. 3).
The utility and impact of the JAM pearls were also assessed by the recipients on a scale of 1 to 10, with 10 being the highest mark: clarity of content (9/10), applicability to the clinic (9/10), relevance to practice (9/10), made practice better (9/10), satisfaction with the format (9/10), and possible recommendation to a colleague (10/10). All values recorded were on a median scale.
Results of this survey indicated that the pearls were very well received and relevant to the target audience. Most of the respondents to the survey were experienced practicing ophthalmologists (mean time in practice, 14.6 years). This indicated that even years into practice, they still need practical clinical concepts that are readily applicable to their daily practice. Not all busy practitioners can or will take time out for regular continuing medical education. In this way, JAM pearls are a convenient modality to update their clinical concepts that can bring positive impact on their performance and patient outcomes. Nearly 90% of the respondents reported accessing the pearls always or very regularly. This demonstrated that the audience was well engaged, the content was viewed with merit, and that the novelty would not wear off. Over 50% of the respondents were private practitioners. This possibly reflects the fact that the content was taken to be clinically relevant and precise, which is of great value to someone in a busy clinic. Almost 50% of the respondents sought pearls pertaining to cornea and anterior segments. This might reflect the current prevalent patient load related to cornea and anterior segment disorders.
Innovative teaching has added value to clinical curricula around the world. Green et al14 showed the value of an internet-based point of care learning portfolio, which was found to be very valuable by internists who took the evaluation examination. Mauck and Litin15 described the clinical pearls endeavor that were launched at the 2001 annual conference of the American College of Physicians. This was based on the premise that physicians inherently enjoy learning from clinical case discussion, appreciate precise clinical points, and love problem solving. Apart from routine didactic theory-based examinations, it has also been shown that clinical pearl-oriented clinical case-based examinations are very well received by medical students as they involve clinical skill application to a practical case scenario.16
The current study has several limitations. The low response rate of 5% may suggest that those who responded to the survey are not representative of the JAM pearls recipients as a whole. As the survey sought information about an activity that spanned the past year, a recall bias may have occurred that could potentially confound the responses. As this is an inherent weakness of retrospective surveys, the responses received had to be taken at face value. One of the aims of dispensing the JAM clinical pearls was also to impact residents and fellows in training. However, the responses from the recipients under training only accounted for approximately 9% of the total responses received, thus the benefit that intended for trainees could not be ascertained.
Nevertheless, the current survey showed that JAM clinical pearls were a unique and valued mode of tele-education, which benefitted the recipients with easily understandable and clinically applicable concepts. This novel teaching tool has a positive impact on clinician performance and hence patient outcomes.
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Survey Form Proforma
- Email address
- Postgraduate in training
- Postgraduate ophthalmologist
- Fellow in training
- Post fellowship
- Years in practice (if applicable)
- Type of practice
- Private clinical practice
- Have you been checking the JAM pearls regularly?
- Very regularly
- Is the clinical message in the JAM pearls clear? (Grade on a scale of 1-10*)
- Is the clinical message in the JAM pearls applicable to the clinic? (Grade on a scale of 1-10*)
- Do the pearls describe clinical conditions of relevance to your practice? (Grade on a scale of 1-10*)
- Are you satisfied with the format of the content? (Grade on a scale of 1-10*)
- Do you think your practice or subject knowledge has improved with the JAM pearls? (Grade on a scale of 1-10*)
- Which subspeciality appealed to you most in terms of content?
- Cornea and anterior segment
- Pediatric ophthalmology and neuro-ophthalmology
- Which type of clinical pearl do you look for specifically?
- How strongly would you recommend a colleague to subscribe to the JAM pearls? (Grade on a scale of 1-10*)
*1 being the lowest mark and 10 the highest.