Virtual Modalities Research Articles

Dementia “e”-consults for Behavioral and Psychological Symptoms of Dementia: Improving access to specialty dementia care for rural Veterans

ABSTRACT Objectives This paper characterizes a telephone-based e-consult program designed to assess and treat behavioral and psychological symptoms of dementia (BPSD) for older rural Veterans. Methods E-consults required geriatricians to conduct chart review and telephone calls to caregivers to determine behavior triggers, prior management attempts, and medications. Pharmacologic and non-pharmacological recommendations were provided with follow-up calls as needed. Results Evaluation of 364 Veterans (M age = 80.8, 32% in rural/distal clinics) showed 97% (n = 355) of E-consult interventions included caregiver dementia education to prepare them for managing disease progression and provide non-pharmacological strategies for BPSD. Ninety-four percent (n = 244) of Veterans received medication guidance. A total of 37,504 travel miles was saved, with an average of 108 miles for each Veteran. Conclusions Findings support continued implementation of telephone and other virtual modalities of assessing and treating BPSD for older Veterans, thereby increasing access to dementia specialists, especially for rural older adults and their caregivers. A limitation to e-consults is the time needed to provide services compared to the maximum workload credit allowed. Clinical Implications Virtual care improves access to Geriatric specialists and semi-urgent care that otherwise is not available. E-consults are effective in providing primary care providers guidance for diagnosis and management of dementia.

Qualitative examination of collaboration in team-based primary care during the COVID-19 pandemic

ObjectiveThe objective of this study was to describe Ontario primary care teams’ experiences with collaboration during the COVID-19 pandemic. Descriptive qualitative methods using focus groups conducted virtually for data collection.SettingPrimary...

Disparities in Use of Virtual Primary Care During the Early COVID-19 Pandemic.

Background: The COVID-19 pandemic increased the use of virtual health care. However, certain factors may disparately affect some patients' utilization of virtual care. Associations between age, racial categories (White or Black), and socioeconomic disadvantage were evaluated during the early COVID-19 pandemic. Methods: This cross-sectional retrospective study included adult patients with virtual or in-person primary care encounters at a large, midwestern hospital system with widespread urban and suburban offices between March 1, 2020, and June 30, 2020. Virtual visits included synchronous video and telephone visits and asynchronous patient portal E-visits. Chi-squared tests and multivariable logistic analysis assessed the associations between ages and racial categories, and area deprivation index with the use of virtual versus in-person primary care. Results: Of 72,153 patient encounters, 43.0% were virtual visits, 54.6% were White patients, and 45.4% were Black. Across equivalent age ranges, black patients were slightly less likely to utilize virtual care than similarly aged White patients, but not consistently across virtual modalities. Women were more likely to use virtual care across all modalities, and individuals >65 years were more likely to use telephone visits and less likely to use video and E-visits, regardless of race. Patients residing in areas with the greatest socioeconomic advantage were more likely to utilize video and E-visits. Conclusions: Differential patterns of utilization emerged across racial categories and age ranges, suggesting that racial disparities are exacerbated depending upon patient age and mode of utilization.

Effects of Virtual Care and Same-Day Access to Integrated Care on Specialty Mental Health Engagement in the Veterans Health Administration.

In the Veterans Health Administration (VA), Primary Care-Mental Health Integration (PC-MHI) clinics offer mental health services embedded in primary care, a strategy shown to reduce overall specialty mental health clinic burden while facilitating prompt referrals when indicated. Among newly initiated patients, same-day access to PC-MHI from primary care increases subsequent specialty mental health engagement. However, the impact of virtual care on the association between same-day access to PC-MHI and subsequent mental health engagement remains unclear. To examine the effects of same-day access to PC-MHI and virtual care use on specialty mental health engagement. We used administrative data from 3066 veterans who initiated mental health care at a large, California VA PC-MHI clinic during 3/1/2018 to 2/28/2022 and had no previous mental health visits for at least 2 years prior to the index appointment. We conducted Poisson regression analyses to examine the effects of same-day access to PC-MHI, virtual access to PC-MHI and their combined effect on subsequent specialty mental health engagement. Same-day access to PC-MHI from primary care was positively associated with specialty mental health engagement (IRR = 1.19; 95% CI 1.14-1.24). Virtual access to PC-MHI was negatively associated with specialty mental health engagement (IRR = 0.83; 95% CI 0.79-0.87). The positive effect of same-day access on specialty mental health engagement was smaller among patients who initiated PC-MHI in a virtual visit (IRR = 1.07) compared to in-person visits (IRR = 1.29; 95% CI 1.22-1.36). Although same-day access to PC-MHI increased overall specialty mental health engagement, the magnitude of this effect varied between in-person and virtual modalities. More research is needed to understand mechanisms of the association between virtual care use, same-day access to PC-MHI, and specialty mental health engagement.

What are COVID-19 Patient Preferences for and Experiences with Virtual Care? Findings From a Scoping Review.

Virtual care became a routine method for healthcare delivery during the coronavirus disease 2019 (COVID-19) pandemic. Patient preferences are central to delivering patient-centered and high-quality care. The pandemic challenged healthcare organizations and providers to quickly deliver safe healthcare to COVID-19 patients. This resulted in varied implementation of virtual healthcare services. With an increased focus on remote COVID-19 monitoring, little research has examined patient experiences with virtual care. This scoping review examined patient experiences and preferences with virtual care among community-based self-isolating COVID-19 patients. We identified a paucity of literature related to patient experiences and preferences regarding virtual care. Few articles focused on patient experiences and preferences as a primary outcome. Our research suggests that (1) patients view virtual care positively and to be feasible to use; (2) patient access to technology impacts patient satisfaction and experiences; and (3) to enhance the patient experience, healthcare organizations and providers need to support patient use of technology and resolve technology-related issues. When planning virtual care modalities, purposeful consideration of patient experiences and preferences is needed to deliver quality patient-centered care.

Use and Effectiveness of Virtual Simulations in Nursing Student Education: An Umbrella Review.

Computer-based virtual simulation in nursing is a rapidly developing field. A summary of current research could benefit nursing faculty who are incorporating this pedagogy into online teaching due to social distancing requirements. This umbrella review aimed to explore the use and effectiveness of virtual simulations in prelicensure nursing education. Our umbrella review approach was informed by The Johanna Briggs Institute guidelines. The 18 included reviews captured the experiences of over 7600 nursing students who engaged with five different virtual (screen-based) simulation modalities. Results indicated that virtual simulations can be effective in developing nursing students' knowledge and psychomotor and psychosocial skills, for example, in medication administration and communication. There was no study that showed a conclusive benefit of virtual simulations for developing clinical reasoning. Students enjoyed virtual simulations, claiming they were accessible, fun, and engaging ways to learn. Many benefits of virtual simulations and some technological challenges were identified in a mapped model. In the future, more rigorous and experimental studies are needed to confirm effects on learning outcomes. Nursing curriculum designers need to define the place and purposes of the pedagogy to ensure that knowledge and skills learned during virtual simulations can be applied to real-world, patient-centered care.

Brain Activation Differences of Six Basic Emotions Between 2D Screen and Virtual Reality Modalities.

To our knowledge, it has been widely studied in Screen-2D modality for the six basic emotions proposed by Professor Paul Ekman, but there are only studies on their positive and negative valence in VR-3D modality. In this study, we will investigate whether the six basic emotions have stronger brain activation states in VR-3D modality than in Screen-2D modality. We designed an emotion-inducing experiment with six basic emotions (happiness, surprise, sadness, fear, anger, and disgust) to record the electroencephalogram (EEG) signals during watching VR-3D and Screen-2D videos. The power spectral density (PSD) was calculated to compare the brain activation differences between VR-3D and Screen-2D modalities during the induction of the six basic emotions. The results of statistical analysis of the relative power differences between VR-3D and Screen-2D modalities for each emotion revealed that both happiness and surprise presented greater differences in the α and γ frequency bands, while sad, fear, disgust and anger all presented greater differences in the α and θ frequency bands, which are mainly observed in the frontal and occipital regions. On the other hand, the six emotions all yielded satisfactory classification accuracy (above 85%) by classification from a subset of power feature of the brain activation states in the same emotion between the two modalities. Overall, there are significant differences in the induction of same discrete emotions in VR-3D and Screen-2D modalities, with greater brain activation in VR-3D modalities. These findings provide a better understanding about the neural activity of discrete emotional tasks assessed in VR environments.

Student Leadership Development Initiative for Medical Students: Lessons Learned From Transitioning to Virtual Modalities.

Leadership training is a necessary component of undergraduate medical education. Our group successfully implemented a student-led organization starting from 2016 (Student Leadership Development Initiative; SLDI) that aimed to provide medical students with exposure to physician-leader career paths in an informal, organic, interactive setting. The COVID-19 pandemic necessitated a shift to online programming, and given the high prevalence of ZOOMTM fatigue, we incorporated monthly, freely available, self-directed modules as an additional leadership training opportunity. The goals of this study are to assess the (1) feasibility of and participation in a virtual student organization focused on leadership training, (2) whether students' perceptions of the importance of leadership were associated with participation in SLDI, and (3) lessons learned from transitioning to virtual modalities. An anonymous, retrospective cross-sectional survey with 13-items was distributed through an email listserv and a 6-question survey was sent to attendees following each virtual group-discussion. A Fisher's exact test was conducted to assess whether the number of modules completed was associated with students' perception of leadership importance. Survey results showed that 85% strongly agreed or agreed that SLDI helped them develop professional goals and career paths, and 74% reported benefits in becoming more compassionate physician leaders and valuing wellness. All respondents completed ≥1 self-directed module, and the students' perception of leadership importance did not influence the number of self-directed modules completed (p > .05). Most participants (63%) attended ≥67% of virtual events, and postevent feedback was positive; however, only 46% of respondents reported meeting someone new at events and 32% reported that they intended on connecting with new contacts. Our results suggest that virtual leadership student-organization, involving small-group discussions and self-directed modules, is feasible and beneficial for medical students. However, the inability to promote meaningful networking opportunities is a major limitation of a virtual training model.

Student perspectives on the use of universal design for learning in virtual formats in higher education

Universal design for learning (UDL) in higher education may be a useful tool in supporting the heterogenous higher education student population, specifically in supporting student academic outcomes and retention. With more students enrolling in digital formatted education, specifically international students, a strong framework must be established to support non-geocentric students. Using survey responses of undergraduate degree-seeking students, this mixed-methods study explored the students’ perceptions and impact of UDL in virtual learning modalities (online courses, independent studies, and virtual study groups). A sample size of 57 participants used a Likert-type survey to assess the student-reported prevalence of UDL techniques in higher education in various virtual learning modalities. Students also discussed the strategies that impacted their experience as learners and the mode of study in which they felt most successful. Implications for practice and research are also presented.

INTEGRATING RESEARCH, TEACHING, AND SERVICE: AN INTERGENERATIONAL BONDING PROGRAM AT THE UNIVERSITY OF NEBRASKA

Abstract To establish an Intergenerational Bonding (IGB) program that pairs undergraduate students at the University of Nebraska at Kearney with older adults of this rural community, we first tested acceptability and feasibility of such a program. We surveyed both groups to identify their interest level in IGB and identify their common interests in activities. Older adults residing in independent dwellings, assisted living homes, and nursing homes and members of community groups were invited to participate in the survey. However, the response rate was low. Given the restrictions of the pandemic, accessing community older adults was challenging. Internet access was low, which made virtual and digital participation modalities impossible; recruitment from assisted living facilities was not successful; and, establishing collaboration with nursing homes was not easy despite initial interest. Building trust and working with community activity group facilitators was ultimately beneficial in recruiting older adults. Collaboration with community-based organizations facilitated the study.

A PILOT STUDY OF AN INTERGENERATIONAL BOOK CLUB: LESSONS LEARNED FOR IMPROVING FEASIBILITY

Abstract Intergenerational book clubs have been successful in reducing ageist attitudes of younger adults (YA) while increasing feelings of social connectedness among older adults (OA; Lohman et al., 2003). We implemented both in-person (Nf11: YA=4, OA=7) and virtual (Nf8: YA=5, OA=3) modalities for an intergenerational book club to increase intergenerational interactions on campus, considering aging researchers’ claim of heightened ageism and exacerbated loneliness following the beginning of the COVID-19 pandemic (Ayalon et al., 2020; Brooke & Jackson, 2020). Both groups met thrice over twelve weeks and completed measures on ageist attitudes (α=.83), engagement with the group (α=.91), and social connectedness (α=.91) each time. There was attrition in both groups (final meeting: Nf9 (in-person) and Nf3 (virtual)). To better understand overall motivations to participate and what factors may have contributed to attrition, we utilized content analysis with participants’ feedback to examine their motivation for joining, what they enjoyed most after participating, and what they would improve. Participants were motivated to join because they enjoyed reading; comparatively, they enjoyed group discussions and hearing different perspectives. Future recommendations include meeting more often, increasing the number and size of groups, and scheduling meetings closer together. The majority wished to continue participating. The data suggest future expansion of intergenerational book clubs on campus are desired to support age-friendly interactions and needed to further examine if these interactions can curb ageism and increase social connectedness among diverse age groups. Discussion will include recommendations regarding measures, lessons learned for an optimal protocol, and next steps.

Comparative study of face-to-face and virtual learning modalities

This paper analyzes university students' academic performance between the periods before the COVID-19 pandemic and the period of the pandemic. Different scientific materials from the Scopus database are analyzed to recognize the possible factors that could alter school motivation and, consequently, the grade point average. The grades of students in eight subjects are also analyzed. The main results show that it is impossible to establish a single criterion to recognize the reasons that make young people lower their grades. In addition, it was observed that teaching methodologies are essential for improvements in the learning process.

Virtual Versus In-Person Head and Neck Physical Examination Training in Medical Students: A Pilot Assessment.

To compare the effect of virtual and in-person head and neck physical examination training events on medical student confidence in performing examination maneuvers and seeking mentorship from otolaryngology faculty and residents. Training events were held with first-year medical student volunteers in 2020 (in-person) and 2021 (virtual). Participants in both cohorts were given didactics on head and neck cancer, trained to perform a head and neck physical examination, and demonstrated their clinical skills to otolaryngology faculty and residents. Pre- and post-training surveys were utilized to assess the following outcomes: participant head and neck cancer knowledge, confidence in performing examination maneuvers, and confidence in seeking mentorship in otolaryngology. Differences in outcomes between training settings were assessed by comparing participant survey responses pre- and post- training. Both in-person and virtual training modalities improved participant confidence in performing the physical examination. There was no significant difference in the degree of improvement between training types. In-person training significantly increased participant confidence in seeking mentorship from otolaryngology faculty and residents (P = .003), while virtual training did not (P = .194). Virtual training modalities are feasible methods of teaching the head and neck physical examination. Instruction through a video conferencing platform has the potential to be incorporated into traditional in-person medical education in a permanent fashion. This pilot study can inform future studies directly comparing in-person and virtual physical examination training modalities.

Development and validation of the online learning process questionnaire (OLPQ) at home for primary-school children and their caregivers.

Despite the increasing use of virtual modalities in schools since the COVID-19 pandemic, no systematic tools exist to evaluate the process of online learning. We developed and validated an Online Learning Process Questionnaire (OLPQ) for assessing online at-home learning among 219 Hong Kong primary-school students and 474 caregivers. Exploratory and confirmatory factor analyses of caregivers' data classified the 58-item OLPQ into 11 subscales: (1) learning aims, (2) environmental structuring, (3) learning environment, (4) time management, (5) engagement in learning activities, (6) persistence, (7) interaction between teachers and students, (8) interaction among students, (9) feedback from the interface, (10) application of learning, and (11) meaning of learning under three learning phases. Confirmatory factor analysis of students' data further categorized the 11-subscale framework into three learning phases: preparatory, performance, and transfer. The OLPQ demonstrated excellent reliability and discriminant validity across caregiver (Cronbach's alpha = 0.98) and student samples (alpha = 0.98). These findings indicate that the OLPQ is a valid and reliable instrument for assessing the online at-home learning process among both students and their caregivers.

Transition from in-person to telehealth standardized patient encounters: A retrospective analysis of 18 cases

IntroductionDue to the COVID-19 pandemic, many pedagogical activities shifted from in-person to virtual modalities, including standardized patient (SP) encounters. While many academic institutions may not have previously been conducting SP encounters virtually, this change provided student pharmacists with new opportunities to learn and practice telehealth techniques, which are important with the continuously evolving healthcare landscape. MethodsThis retrospective study analyzed pharmacy student performance on and perceptions of SP cases in fall 2019 (in-person) and fall 2020 (telehealth) semesters. The primary objective was to compare average total scores on SP cases from fall 2019 (in-person) and fall 2020 (telehealth) for first-, second-, and third-year pharmacy students (P1, P2, and P3, respectively). Secondary objectives were to compare average scores from case-specific and relationship and communication (R&C) checklists, as well as to describe student perceptions of the pedagogy. ResultsTotal scores on SP cases decreased from in-person to telehealth for the average of all P1 SP cases, but not for P2 or P3 cases. Case-specific scores did not change, but R&C scores decreased significantly across all three years. Student survey data revealed difficulty with communicating effectively and building rapport via telehealth. ConclusionsOverall, student performance on in-person vs. telehealth SP encounters was similar, though P1 students performed more poorly on SP cases conducted via telehealth compared to P2 or P3 students. Thus, faculty could consider focusing on in-person encounters for early learners before introducing virtual encounters. This study also highlights the difficulty in establishing rapport when communicating with patients via telehealth.

Avatar and distance simulation as a learning tool - virtual simulation technology as a facilitator or barrier? A questionnaire-based study on behalf of Netzwerk Kindersimulation e.V.

Virtual simulation modalities have been implemented widely since the onset of the severe acute respiratory syndrome coronavirus 2 pandemic restrictions in March 2020, as educators face persistent restrictions to face-to-face education of medical students and healthcare professionals.There is paucity of published data regarding the benefits and barriers of distance and avatar simulation training modalities. Following a 2-day virtual pediatric simulation competition facilitated by Netzwerk Kindersimulation e.V., using remote human avatars and distance simulation, we conducted a multicenter survey to explore the advantages and challenges of avatar and distance simulation among participants. We used a modified Delphi approach to draft and develop the 32-item online questionnaire with 7-point Likert-like scales (7 being the highest rating). Twenty participants answered our questionnaire. Respondents indicated both a high overall satisfaction (median of 5.0 [Q25-Q75: 4.0-6.0] ) for avatar and distance simulation 6.0 (5.0-6.0), respectively, as well as a high achieved psychological safety with both simulation types (5.0 [4.0-6.0] vs. 5.0 [4.0-6.0]). The most frequently reported profits of avatar and distance simulation included the elimination of travel distances, associated lower costs, less time spent attending the education activity, and effective communication and leadership training, especially with avatar simulation. Most often named challenges were technical problems, limited reception of non-verbal cues and a spatial distance from the team/educator. Based on the results of this pilot study, avatar and distance simulation can be employed successfully and appear to be good supplements to face-to-face simulation. Other studies are warranted to further explore the effectiveness of various types of virtual simulation compared to conventional presential simulation. We suggest using avatar-based simulation for targeted communication and leadership skills training and the application of distance simulation to bring simulation experts virtually to remote places where educator resources are lacking.

1.94 Contrasting Virtual and In-Person Family Therapy Teaching

Family therapy using reflecting teams (RT) is one key psychotherapy training modality within psychiatry residencies. Historically, RTs have been facilitated in-person. Due to COVID-19 restrictions, the authors created an analogous RT teaching process via Zoom. The purpose of this study was to contrast in-person vs virtual family therapy teaching modalities through learner-reported survey data.

Variation in patient demographics across different modalities of tele-oncology.

394 Background: TeleOncology encompasses the delivery of care virtually though modalities such as electronic consultation (e-consult), telephone and video visits. The National TeleOncology (NTO) program was created by Veterans Affairs (VA) to address growing disparities in care across the VA network. Through NTO, subspecialty hematologists/oncologists can provide recommendations and care for patients located at VA centers across the county. We aimed to investigate differences in patient utilization of available forms of TeleOncology. Methods: NTO was started in 2020 and offers virtual care to over 20 VA sites. Patient visits were catalogued across different forms of TeleOncology including telephone, e-consult (chart review only), VA Video Connect (VVC, synchronous video visit with patient at home), and Clinical Video Telehealth (CVT, synchronous video visit with patient at local VA). Total and unique patient encounters were analyzed based on patient age, gender, race, care assessment need (CAN) score (predictor for identifying patients at high-risk for poor outcomes), and patient rurality. Modalities of telehealth were then compared. Results: 3008 unique patients and 5921 encounters were recorded (October 2019-May 2022). The majority of patients accessed care by CVT visit (n = 1915). Patient characteristics were statistically different between the modes of TeleOncology. Patients participating in CVT were older (Mean 70.5 (95% CI 69.97-70.97) vs 65.5 years old (95% CI 64.62-66.68) and had higher CAN scores (mean score 82 (95% CI 80.96-82.74) vs 69 (95% CI 66.76-70.74)), compared to patients assessed through e-consult. Conversely black and female patients were overrepresented in the e-consult group compared to the CVT group (Table). Patients receiving care by telephone were more often located in a rural or highly rural region compared to those seen through VVC (71.5% vs 52%). Conclusions: The NTO program offers unique insights into utilization patterns of different forms of virtual care. Patient characteristics were not similar across the e-consult, telephone, and video visit groups. Importantly racial and gender disparities were noted, with African American and female patients, being disproportionately cared for through chart review only compared to a video visit. These results represent a first step in understanding how patients’ interface with virtual care modalities. Future studies could investigate how patient and system factors might influence observed patterns.[Table: see text]

Teaching resources for the European Open Platform for Prescribing Education (EurOP2E)—a nominal group technique study

The European Open Platform for Prescribing Education (EurOP2E) seeks to improve and harmonize European clinical pharmacology and therapeutics (CPT) education by facilitating international collaboration and sharing problem-based, online, open educational resources. The COVID-19 pandemic forced teachers to switch to virtual modalities, highlighting the need for high-quality online teaching materials. The goal of this study was to establish the online problem-based teaching resources needed to sustain prescribing education during the pandemic and thereafter. A nominal group technique study was conducted with prescribing teachers from 15 European countries. Results were analyzed through thematic analysis. In four meetings, 20 teachers from 15 countries proposed and ranked 35 teaching materials. According to the participants, the most necessary problem-based-online teaching materials related to three overarching themes. Related to learning outcomes for CPT, participants proposed creating prescription scenarios, including materials focusing on background knowledge and resources on personalized medicine and topical/ethical issues such as the prescription’s impact on planetary health. Second, related to teaching, they proposed online case discussions, gamification and decision support systems. Finally, in relation to faculty development, they recommend teacher courses, a repository of reusable exam questions and harmonized formularies. Future work will aim to collaboratively produce such materials.

Educating the Next Generation of Global Neurosurgeons: Education for Medical Students Interested in Global Pediatric Neurosurgery

Objective: Education is a critical component of global pediatric neurosurgery with increasing attention being placed on the role of medical students in global neurosurgery. We provide a background of education for medical students interested in global pediatric neurosurgery, present existing pediatric neurosurgery resources with a focus on virtual modalities, and describe the need to create accessible resources for medical students.
 
 Methods: A narrative and anecdotal review was performed.
 
 Results: Education of medical students regarding pediatric neurosurgery is particularly important due to multidisciplinary collaboration and advocacy. Benefits of virtual education include accessibility across the world, convenience, easily updatable nature, incorporation of multimedia, minimal cost, and personalization. Existing online resources include courses focused on medical webinars, general courses, on-demand content, journals, online simulation, and social media. Few resources focused exclusively on medical students exist in pediatric neurosurgery, and none address the intersection of pediatric neurosurgery and global neurosurgery. Additional educational resources that incorporate neurosurgical knowledge with special applicability to the medical student population will capture the interest of medical students, while those incorporating global health elements will develop a commitment to global neurosurgery.
 
 Conclusion: Education of medical students is important for the sustainability of global pediatric neurosurgery. The development of educational resources for medical students interested in global pediatric neurosurgery should be encouraged.