Clinical Education Research Articles

Multifaceted Interventions to Enable Elimination of Clinician-ordered Blood Smear Reviews: A Rural Academic Medical Center Experience

Abstract Introduction/Objective Blood smears (BS) evaluate a variety of clinical disorders. At Geisinger, clinician ordered pathologist review of blood smears (CBS) have increased despite usage of highly sophisticated hematology analyzers and automatic blood smear (ABS) review criteria. We hypothesized that CBS impact pathologists’ and technologists’ workloads and increase costs and turn-around times, with rare improvement in value-based patient care. This study aimed to analyze CBS ordering practices and improve the utilization of BS review. Methods/Case Report In October 2020, a prospective CBS utilization study was completed by 8 clinical pathologists for 172 CBS. Subsequently, a clinical question was required for CBS orders from January 1, 2022, to January 1, 2023, to investigate clinician ordering practices based on campus, department, and indications. Findings were used to support new interventions including: clinician education; cancellation of repeat BS ordered within 24 hours, creation of alternative tests (schistocyte technologist smear review, clinician order for independent slide review), standardization of morphology reporting, ABS audits, and elimination of orderable CBS replaced by an electronic BS review request, that is reviewed by a clinical pathologist prior to determine if a BS is indicated. Results (if a Case Study enter NA) Part of the Conclusions section for Lab Practice abstract. Conclusion Prospective utilization audit of 172 CBS orders showed 17% changed clinical management. Audit of 3,693 CBS orders demonstrated common reasons for review included tick-borne illness, hemolysis, erythrocytosis, thrombocytosis, and iron deficiency anemia. Systematic implementation of multiple interventions enabled the elimination of CBS, with no known adverse effect on patient management to date. The streamlined BS review guidelines allowed for better-allocation of resources, appropriate patient turn-around times, empowerment of laboratory technologists and reduced hospital costs. We propose maximizing the incorporation of technologist skills to improve the utilization and efficiency of BS reviews and establishing standardized, evidence-based, and institutional- specific guidelines to determine BS reviews.

Unlocking ChatGPT’s potential and challenges in intensive care nursing education and practice: A systematic review with narrative synthesis

BackgroundThe advancement of artificial intelligence (AI) in healthcare and nursing promises to enhance clinical outcomes and education. This review emphasizes integrating AI chatbots, specifically ChatGPT, into Intensive Care Units (ICU) to transform nursing education and practices, while addressing associated risks and ethical challenges. PurposeTo evaluate ChatGPT’s utility in ICU nursing education and practices, assessing its effectiveness and develop strategic recommendations for its future incorporation into critical care. MethodsThis review employs systematic literature with narrative synthesis, adhering to PRISMA guidelines. DiscussionFive of 1,091 identified studies were eligible. These studies illustrate AI-driven applications’ potential in clinical decision-making and educational efforts, emphasizing the need for improved AI accuracy, robust guidelines, and measures to address data privacy concerns to ensure reliable integration. ConclusionChatGPT presents promising benefits for ICU applications but requires careful management. Ongoing research and adherence to ethical standards are essential to optimize its use in critical care. Tweetable abstractExplore how #ChatGPT revolutionizes ICU nursing & education, blending AI capabilities with ethical, human-centered care. #ICM #AIinHealthcare

Summer Camp Clinical Placements in Young Families Nursing: An Interpretive Description Study.

Obtaining meaningful clinical experiences with paediatric and perinatal (young families) populations is increasingly challenging for nursing programs. Care for this population has largely moved to outpatient and tertiary settings. Therefore, a current trend is to use non-traditional clinical settings. While summer camps offer rich learning experiences for nursing students, they are seldom used as clinical placements. Faculty at an Atlantic Canadian university sought a novel way to engage students in young families' learning by partnering with overnight summer camps, staffed by counsellors, camp administrators, and on-site nurses. Campers included those with lived experience of cancer, diabetes, physical and developmental challenges, and socioeconomic challenges. This study assesses how young families course outcomes were met by an innovative clinical experience within a Bachelor of Nursing program and describes the perceptions and experiences of those involved. Study participants included students (n = 4), camp directors (n = 3), a camp nurse (n = 1), and the clinical educator (n = 1). Data collection involved semi-structured interviews and a focus group. Interpretive description methodology was used to identify themes and patterns related to overarching research questions. Students met the outcomes and overall participant perceptions and experiences were positive. However, some participants shared constructive critiques for future consideration. Nursing students who completed a young families clinical placement at summer camps met course outcomes, and those involved reported both positive experiences and constructive critiques for future consideration.

Disparities between rural and urban communities: Response to 18-months of diet and exercise versus control for knee osteoarthritis and overweight or obesity.

The study objective was to determine whether the clinical response of older adults with knee osteoarthritis and overweight or obesity to 18 months of diet and exercise or attention control interventions differed between participants from rural versus urban communities. Participants were 823 older adults (mean age, 64.6 years; 77% women) with knee osteoarthritis, overweight or obesity, who resided in rural (N = 410) and urban (N = 413) counties in North Carolina. All were enrolled in the WE-CAN clinical trial that randomly assigned participants to either 18-months of diet and exercise (D+E) or attention control (C) interventions. General linear models were used to examine differences in clinical outcomes between rural and urban groups after adjusting for covariates. The rural group had significant differences (P<.05) at baseline in clinical outcomes, education, comorbidities, medication use, and income compared to the urban dwellers. After adjusting for baseline differences, the group (rural, urban) by treatment (D+E, C) interactions for WOMAC pain (rural: D+E-C= -0.63,95%CI,-1.31 to 0.06; urban: D+E-C= -0.29,95%CI,-0.99 to 0.41;P=.50) and WOMAC function (rural: D+E-C = -4.60,95%CI,-6.89 to -2.31; urban: D+E-C = -1.38,95%CI,-3.73 to 0.94;P=.054) indicated that the groups responded similarly to the interventions. Among participants with knee osteoarthritis and overweight or obesity, diet and exercise compared to attention control led to similar pain outcomes in rural and urban dwellers that favored diet and exercise; the possibility there may be greater differential efficacy in functional outcomes among rural participants needs further study.

A Primer for the Clinician Educator: Supporting Excellence and Promoting Change Through Storytelling

A Primer for the Clinician Educator: Supporting Excellence and Promoting Change Through Storytelling

“3 + X D” structured report in radiology standardized resident training: Can it meet high-level teaching objectives?

PurposeTo evaluate the impact of the innovative “3 + X D” structured report (SR) designed based on Bloom’s taxonomy on the learning outcomes of radiology residents during standardized training. MethodsThis is a prospective study that recruited 120 radiology residents from our hospital between 2020 and 2022. Randomly selected 60 residents from the 2020 grade to constituted the control group, and randomly selected 60 residents from the 2021 grade to formed the experimental group. The former group was trained utilizing the Free-text Reports (FTR) template, while the latter group received training with the “3 + X D” structured reports (SR) template. The learning outcomes of both groups was evaluated utilizing both objective and subjective measures. Objective assessments encompassed examinations of theoretical knowledge, diagnostic skills, and total scores, aligning with the cognitive domains of remembering, understanding, applying, and analyzing as outlined by Bloom’s Taxonomy. Subjective assessments, on the other hand, comprised survey questionnaires administered to residents and feedback from clinical instructors, which correlated with the higher-order cognitive level of analyzing, evaluating, and creating within Bloom’s Taxonomy. ResultsOn 60 residents (mean age, 24.15 years ± 2.11[SD]; 25 male) from control group, and 60 residents (mean age, 24.58 years ± 1.88 [SD]; 27 male) from experimental group. Following the training, significant improvements were observed in the theoretical knowledge, diagnostic skills, and total scores for both groups (p < 0.001). Furthermore, the experimental group demonstrated significantly higher diagnostic skills and total scores compared to the control group (p < 0.001). However, no significant difference was observed in the theoretical knowledge exam between the two groups (p = 0.236). The questionnaire used for subjective assessments had good reliability (Cronbach α was 0.826) and acceptable validity (The KMO was 0.692). Additionally, the survey questionnaires indicated that the experimental group rated higher than the control group in terms of cultivating imaging thinking ability, diagnostic confidence, diagnostic speed, and the convenience of the templates (p < 0.001). Clinicians’ feedback scores for the experimental group markedly surpassed those for the control group (p < 0.05). ConclusionsUtilizing the “3 + X D” SR template grounded in Bloom’s taxonomy for training, the professional competency of radiology residents, particularly their diagnostic skills, saw a marked enhancement, successfully meeting the higher-level educational objectives. Consequently, the “3 + X D” SR template is highly recommended for the standardized training of radiology residents.

Designing a virtual reality system for clinical education and examination

The COVID-19 pandemic clearly showed how much medical and clinical students’ education relied on physical instruction and examination. The work presented here was born by the fact that medical and clinical education had to be suspended during the social distancing phase of the pandemic. This work presents the lessons learned from creating a virtual reality system (VTRACS) for educating and assessing clinical students on a limited budget. Our work showed that clinical education could be done in a virtual space with a minimal virtual reality setup and a low-cost virtual reality headset.

The Use of Simulation as a Component of Clinical Education in Health Professional Entry to Practice Programs

The Use of Simulation as a Component of Clinical Education in Health Professional Entry to Practice Programs

Cultural considerations when working with Jewish students and supervisees

ABSTRACT The author examines the marginalization of Jewish identities in multicultural clinical education and supervision amid rising antisemitism in the U.S., proposing the use of cultural democracy to address these issues. He critiques the erasure of Jewish identity due to the neglect of Jewish backgrounds in key theories and inaccuracies in clinical literature. He further underscores the importance of Jewish cultural considerations, including accommodating Jewish practices such as holidays, Sabbath observance, mourning customs, and dietary laws, while advocating for flexibility and sensitivity. Finally, he addresses considerations when supervisees experience antisemitism from a person at the center of a clinical encounter.

Barriers and Facilitators to Mental Health Service Integration: A Scoping Review.

Mental health service integration currently has no consensus definition and exists in a variety of settings, including primary care, addiction treatment and chronic disease management, and mental health nurses have often experienced efforts at service integration with varying degrees of success. The intent of mental health service integration is to enable collaboration between mental health services and other healthcare providers to improve service access and the care provided to individuals with mental health issues or mental illness. This scoping review aimed to explore service integration between mental health services and with a specific focus on those evaluated in peer-reviewed, primary literature, to determine facilitators and barriers to service integration. Using the Arksey and O'Malley's framework for scoping reviews, we located 3148 studies, with screening narrowing final papers for inclusion to 18. Facilitators to service integration included clinician education, adequate resourcing and an interdisciplinary approach, while barriers included staff factors such as a reluctance to work with individuals with mental illness, consumer level barriers such as poor mental health literacy, 'territorialism' among staff and organisational climate. Research indicates that service integration is an effective means to detect and treat mental health issues in settings that do not traditionally provide mental health care, lowering the costs of providing healthcare and providing improved care for mental health needs; however, there are several barriers to be addressed to achieve full implementation of integration models.

12 tips for integrating the 12 Practitioner Values to improve clinical supervision for neurodiverse learners

With the NHS Long Term Workforce Plan requiring clinical placements to accommodate up to 50% more learners, the pressure on clinical educators to maintain high-quality learning environments is becoming increasingly intense. Neurodiverse learners face significant barriers in busy, fast-paced environments, making the cultivation of supportive and adaptive learning spaces essential to ensure all learners have the opportunity to thrive in a healthcare system under immense demand. This article is aimed at empowering clinical educators to lead inclusive placements through implementation of advanced supervision skills to support neurodiverse learners. These are presented as 12 practical strategies, each aligned with the 12 Practitioner Values, for fostering inclusive professional relationships. By offering actionable ‘tips’, this article addresses both the moral imperative to meet diverse learning needs and the systemic necessity of building a more inclusive workforce.

Caring for Transgender and Gender Diverse Prehospital Patients: a NAEMSP Position Statement and Resource Document

ABSTRACT Transgender and gender diverse (TGD) people have long faced significant barriers to safely accessing medical care–especially gender-affirming care, which has been shown to strikingly improve health outcomes like suicidality and depression. In the prehospital setting, gender-affirming care amounts to showing respect for the TGD patient’s identified gender and maintaining a safe environment that fosters a positive therapeutic relationship throughout the encounter. This represents a challenge for many Emergency Medical Services (EMS) systems due to the lack of TGD-specific training for EMS clinicians, a paucity of TGD-specific research to inform EMS education and clinical care, and in some cases the resistance of EMS clinicians to such training. Transgender and gender diverse people are facing a regression in legal access to essential medical care. With this position statement, NAEMSP joins other professional medical societies in providing recommendations to improve care for TGD patients, thereby affirming TGD individuals’ right to exist as their authentic selves, as well as their entitlement to the same high-quality prehospital medical care as their cisgender peers. NAEMSP Recommends: EMS clinicians should maintain basic cultural competency regarding TGD populations, including familiarity with TGD-related health and health care disparities, consideration of TGD populations as underserved, and understanding the centrality of stigma and transphobia in creating disparities and other challenges which complicate daily life for TGD people. EMS clinicians should demonstrate cultural humility towards the TGD community, which includes self-assessment of knowledge gaps, as well as openness to new or unfamiliar ideas, information, and advice from those with different lived experiences. EMS clinicians should understand basic TGD-specific terminology and use appropriate language–including patient-identified name and pronouns–during direct patient care, in handoffs, and in documentation. EMS clinicians should treat a patient’s TGD status as sensitive health information and take care not to inadvertently disclose this information without the patient’s express permission. EMS clinicians should have a basic understanding of social transitioning and of gender-affirming medical and surgical treatments. EMS clinicians should employ a trauma-informed approach when caring for TGD patients. EMS education and training should incorporate learning domains that address comprehensive care for TGD patients, with educational content providing the specific knowledge and skills required to promote equitable care. EMS workplaces should implement policies to improve recruitment and retention of TGD personnel, covering harassment protection, non-discrimination practices, inclusive working environments, equal advancement opportunity and tailored employee benefits. Future EMS research should focus on elucidating the disparities in and barriers to prehospital care of the TGD patient population with emphasis on patient experience and education of prehospital clinicians.

Environmental sustainability in intensive care: the path forward. An ESICM Green Paper.

The European Society of Intensive Care Medicine (ESICM) Green Paper aims to address the challenge of environmental sustainability in intensive care and proposes actionable strategies for integrating sustainability into intensive care unit (ICU) stakeholder actions. The ESICM Executive Committee appointed a task force of topic experts and ESICM committee representatives to develop the ESICM Green Paper. The task force convened biweekly from January to June 2024, identifying key domains for environmental sustainability and prioritizing actions. Drafts were iteratively refined and approved by the ESICM Executive Committee. Climate change will impact activities in intensive care in many ways, but also the impact of ICU activities on the environment is considerable; drivers for this include extensive resource use and waste generation in ICUs from energy consumption, use of disposable items, and advanced therapies for critically ill patients. The ESICM Green Paper outlines a structured approach for ICUs to reduce their environmental impact, emphasizing energy efficiency, waste reduction, and sustainable procurement. Furthermore, it endorses the need for awareness and education among healthcare professionals, integration of sustainability into research, and sustainable policies within scientific societies. The ESICM Green Paper reviewed the relevance of climate change to intensive care and provided suggestions for clinical practice, research, education, and ESICM organizational domains. It underscores that reducing intensive care's ecological footprint can coexist with high-quality patient care. Promoting a resilient, responsible healthcare system is a joint responsibility of all ICU stakeholders.

Essential Competencies for Oncology in Physical Therapist Professional Education Programs: Results of a Mixed Methods Modified Delphi Study.

The objective was to establish consensus-based competencies for oncology within physical therapist professional education programs in the United States. A mixed-methods approach implementing a sequential exploratory design that included 3 phases was used to establish oncology competencies for physical therapist professional education programs. Participants in each phase were physical therapists representing diverse practice settings, experience levels, and geographical regions. Student physical therapists were included in phases 2 and 3. Three online focus groups were followed by an in-person group discussion to establish cancer-related themes, domains of practice, and competencies. Participants evaluated the competencies in a 3-round modified Delphi study for relevance and clarity. Each competency required 80% consensus using a Likert scale (1 = not at all relevant/clear, 5 = extremely relevant/clear). It was not accepted if a competency did not meet the 80% threshold by the end of round 3. Six domains of practice and 28 competencies were developed and evaluated. Within the 6 domains, 21 competencies were accepted: general cancer concepts (n = 4), musculoskeletal system (n = 3), neurologic system (n = 5), integumentary system (n = 2), cardiovascular and pulmonary system (n = 5), and involvement of multiple systems across the lifespan (n = 2). Along with the 21 competencies, participants also recommended 11 overarching oncology themes to incorporate into physical therapist professional education programs. Delivering cancer content using a body systems approach was recommended. As the number of survivors of cancer continues to grow, integration of these essential competencies within physical therapist professional education programs will improve the profession's capacity to provide quality care to meet the societal need of persons living with and beyond cancer. Academic and clinical educators should integrate these competencies to ensure that physical therapist professional education programs appropriately prepare physical therapists for providing care for persons living with and beyond cancer across the lifespan.

The impact of resilience on academic performance with a focus on mature learners

BackgroundResilience is an essential psychological trait that empowers individuals to adapt and thrive in the face of challenges. Although it is acknowledged that health professionals need to possess high levels of resilience, there has been limited research comparing how different groups of health students, particularly school leaver undergraduates and mature age graduate entry students, develop resilience in their coursework.MethodsThis study combines both objective (academic grades with validated survey results) and subjective data (interviews) to compare how resilience is related to academic coursework performance for two groups of pharmacy students: the mature age graduate entry (GE, N = 64) learners and school leaver undergraduate (UG, N = 208) learners. We employed a sequential explanatory mixed methods design using surveys, academic performance data and semi-structured interviews. The survey tapped constructs related to resilience (burnout, stressors and coping methods) while the interviews elicited a more nuanced understanding of individual and environmental factors.ResultsAlthough there was no statistical difference in burnout experience between the two groups, GE students exhibited more positive resilience attitudes than UG when selecting resilience statements on the survey. Both cohorts indicated in the survey that engaging in distraction activities (physical exercise, sleeping, listening to music, anything other than the stressor) was their most preferred method of relieving stress. Within UG student survey responses, those who indicated support from partners, friends and family had better academic performance, while those who did not report coping methods did worse academically. The three key environmental factors we identified that contributed to both undergraduate and graduate entry resilience were workload, feedback provision and psychosocial support.ConclusionsCurrently, there is still a need for resilience programs geared at academic success to be implemented in higher education. This study provides objective evidence of academic success coupled with exploration into the nuances of resilience amongst different student groups. It not only highlights the differing resilience development strategies and burnout coping mechanisms in emerging health professionals, but showcases the juxtaposition of two different learner groups (UG and GE students) within a discipline. The cross-cohort facilitation of learning as in the discipline-specific strategies identified can help both groups develop resilience and inform future innovations. By comparing mature-age graduate students and younger-in-age undergraduate students, we identified a wider range of strategies and more positive attitudes to burnout in mature-age students. Health and clinical educators in university health degrees, clinical placements and clinical workplaces can develop effective training materials based on findings from this study to 1) assist undergraduate younger-age health students with developing resilience and 2) further refine mature-age health students’ and practicing health professionals’ resilience in today’s fast-paced clinical workplaces.

Role‐play‐based coaching program for empowering clinical educators

Role‐play‐based coaching program for empowering clinical educators

Development of the World Federation of Hemophilia Shared Decision-Making Tool.

The use of shared decision-making (SDM) in clinical settings is becoming more prevalent. The evolving and increasingly complex treatment landscape of haemophilia management has augmented the need and desire for SDM between patients and their healthcare team. SDM tools have been used in other chronic conditions and can be an effective form of education for patients and clinicians. The World Federation of Hemophilia (WFH) partnered with people with haemophilia (PWH), patient advocacy groups, and healthcare practitioners to form an expert working group to develop an educational tool for PWH and their caregivers. The primary objectives included educating PWH on the available prophylactic treatments and facilitating discussion between PWH and their healthcare team. The tool was proposed and developed by the expert working group, workshopped at conference round tables, and evaluated in two focus groups. The interactive WFH SDM Tool guides users through the SDM treatment journey and provides an opportunity for reflection on current disease impact and treatment preferences, educational fact sheets and videos, and a comparison between treatment classes. Two forms of the SDM Tool are available: an online platform with a summary page that may be printed and shared and a printable workbook. All evidence in the tool is based on the prescribing information or phase III clinical trial publications. The Tool will be updated twice each year. The WFH SDM Tool is the first available resource that translates published guidance on SDM in haemophilia into a practical, user-friendly tool aimed at facilitating patient-centred treatment decisions.

5099 Capturing the Patient Voice for Diabetes Eye Exams

Abstract Disclosure: S. Du: None. S. Lambrechts: None. M. Freeby: None. M. Han: None. Background: Diabetic retinopathy (DR) is a leading cause of blindness among adults 20-74 years old. Ophthalmic exams are recommended every 1-2 years for type 2 diabetes patients with minimal to no DR. The 50th percentile Integrated Healthcare Association benchmark for DR screening is 49%, but at our academic medical center, the completion rate is 30%. Potential barriers to screening noted in the literature include lower levels of education, lack of knowledge about DR, and financial barriers. Objective: To understand motivating factors and barriers to DR screening among patients in our health system. Methods: We utilized the Patient Voice qualitative research method to uncover themes and identify interventions to improve care delivery. The literature was synthesized to develop a structured interview guide. From our urban academic health system, 15 patients were randomly selected for interview, six of whom had completed the “Diabetes Eye Exam” care gap and nine that had not. Interviews were transcribed and coded for thematic analysis. Results: Six opportunity areas were identified. 1) There are currently only six retinal cameras located across primary and specialty care clinics serving more than 38,000 diabetes patients. 67% of patients felt the current clinic locations were inconvenient, with distant locations and long travel times. 2) 20% of patients expressed that they would like increased flexibility of appointments offered, such as evening, weekend, and same day appointments. 3) Patients were motivated by automated diabetes eye exam specific reminder messages and appreciated the ability to self-schedule within the patient portal. 47% of patients wanted yearly reminder messages, while 40% had no preference. 4) 53% of patients expressed that they did not fully understand DR or were confused about the difference between an optometrist exam and diabetes eye exam. 5) 40% of patients completed their eye exam with their local optometrist and found this to be a more convenient option. One patient expressed that she wished her doctor had informed her that she could complete her diabetes eye exam at a local optometry clinic. 6) If patients do choose to complete their exam with their local optometrist, they would like reminders to send their records to their primary care physician or endocrinologist. A more streamlined processes to upload outside records through the patient portal would decrease this barrier. Conclusion: It is important to engage patient stakeholders and understand their needs to improve overall experience and close care gaps. Through the Patient Voice, we learned that factors such as driving distance, traffic, scheduling, and issues with uploading records are major barriers to care gap completion. Convenient clinic locations, education, and reminder messages are motivating factors. Future work will focus on developing and implementing solutions in each opportunity area. Presentation: 6/1/2024

Complex Decision-Making in Paediatric Intensive Care: A Discussion Paper and Suggested Model.

Paediatric Intensive Care Units (PICU) are complex interdisciplinary environments where challenging, high stakes decisions arefrequently encountered. We assert that appropriate decisions are more likely to be made if the decision-making process is comprehensive, reasoned, and grounded in thoughtful deliberation. Strategies to overcome barriers to high quality decision-making including, cognitive and implicit bias, group think, inadequate information gathering, and poor quality deliberation should be incorporated. Several general frameworks for decision-making exist, but specific guidance is scarce. In this paper, we provide specific guidance on collaborative complex decision-making for PICUs. The proposed approach is on principles of procedural justice and pragmatic hermeneutics. The process encompasses set-up/planning, information gathering, question formulation, analysis (perspectives, values, and principles), action plan development, decision documentation, and a review and appeal mechanism.The process can be adapted to suit other clinical contexts. Research evaluating the process, exploring how best to develop education for clinicians, and how to build a culture that values high quality deliberation, is worthwhile.

Development of a mobile application to increase motivation, engagement &amp; teaching activity of clinical faculty using gamification principles

Background: Clinician teachers (CT) have historically felt undervalued and underappreciated. One technology used to increase motivation is gamification: the process of inserting elements of game-playing into activities that are not usually associated with games. We developed a mobile application that rewards CTs using in-app gamification techniques to increase CTs motivation. This program was implemented specifically in a regional campus setting, Mississauga, Ontario. Methods: A cross-platform application that rewards physicians for their clinical teaching hours was created. This consisted of a star grading criteria where each physician was awarded depending on the number of hours completed. End-user perceptions of the application were evaluated using a survey with a Likert scale and open-ended questions. Survey results were collated with descriptive statistics and thematic analysis. Results: The TutorTracker application was developed implementing a live gamification algorithm. It allows physicians to view their hours completed, rewards obtained, and add additional hours. The majority of CTs agreed or strongly agreed that the application was user-friendly, easy to navigate and enjoyed the rewards provided. Major themes that emerged were regarding additional features and full integration of such an application for rewarding teaching efforts. Conclusions: Gamification principles have been implemented in a cross-platform application allowing CTs to be rewarded for their teaching. The next steps would be to formally quantify the effects and advantages of using the application to increase the motivation of tutors.