Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 8 appraisals
Journal of robotic surgery
Technology-enhanced training in basic robotic surgical skills: a systematic review
Robotic surgery has seen substantial growth, however training access remains limited by resources and time-intensive credentialling pathways. Technology enhanced learning may address these barriers whilst improving training efficiency and assessment objectivity. We aimed to systematically evaluate technology-enhanced approaches to basic robotic surgical skills training. This systematic review followed PRISMA guidelines with prospective registration (OSF: V93MZ). MEDLINE (via OVID), Embase, and the Cochrane Library (CENTRAL and CDSR) were searched on 23 May 2025 without date restrictions. Technologies included virtual reality, augmented reality, sensor-based systems, video review, and performance feedback. Risk of bias was assessed using the RoB-2 and ROBINS-I tools, and certainty of evidence using GRADE. Narrative synthesis was utilised given methodological heterogeneity, with reported outcomes mapped to the Kirkpatrick model of training evaluation. Seventeen studies involving 484 participants were included (10 randomised trials, 7 prospective cohort studies; 16 single-centre). Technologies comprised virtual reality (7), sensor-based systems (5), performance feedback (3), video review (1), and augmented reality (1); no eligible artificial intelligence studies were identified. Virtual reality, utilised within bespoke robotic simulators, demonstrated accelerated learning curves, although some systems required more repetitions than traditional robotic simulator-based training. The single augmented reality study improved instrument velocity. Sensor-based force measurement devices improved force application and ergonomics. Video review improved accuracy but temporarily increased completion time. Multimodal feedback systems outperformed conventional feedback. Evidence was concentrated at Kirkpatrick level 2 (learning); one study reported only level 1 (reaction) data, with no studies reporting level 3 or 4 outcomes. Risk of bias was low in randomised studies and low-moderate in non-randomised studies. Technology-enhanced basic robotic skills training has evidence supporting improved performance outcomes, accelerated learning curves, and enhanced objective assessment capabilities. Gaps persist for basic skills training in augmented reality, artificial intelligence, and docking and setup. Standardised competency assessment frameworks are required to evaluate these rapidly progressing tools.
21 July 2026
Read appraisal →JMIR medical education
Training Empathetic Communication Skills in Medical Students With a Role-Prompted GPT-4o Chatbot: Quasi-Experimental Intervention Study
BACKGROUND: There is growing concern that artificial intelligence (AI) may diminish the quality of human relationships. However, in a context of widespread social importance (empathetic conversations between doctors and patients), AI can actually improve human conversational skills, potentially enhancing professional relationships. Recent advances in AI allow for realistically role-prompted counterparts for practicing professional conversations, enabling relational learning without the need for human counterparts. OBJECTIVE: This study aimed to show the effectiveness of AI chatbots for learning professional communicative skills in medical education. Specifically, we hypothesized that a single conversation with an AI chatbot improves communication skills in medical students across 4 different conversational competencies. METHODS: We conducted a quasi-experimental intervention study involving 4 distinct role-prompted scenarios (ie, shared decision-making, motivational interviewing, sexually transmitted diseases, and breaking bad news)-each designed to elicit in-depth empathic conversational skills aligned with key learning objectives in medical curricula. Students rated their competence for the 4 scenarios before and after a conversation with GPT-4o (OpenAI) using default settings, without fine-tuning. We expected higher perceived communication competence (PCC) in their conversation topic after the interaction compared with before the interaction in a 2-sided paired t test. Participants received AI-generated feedback, which they rated regarding adequacy. Post hoc analyses addressed gender and case effects, feedback adequacy, and prevalues in PCC. RESULTS: This study shows that a role-prompted GPT chatbot improves PCC in 162 medical students after a single conversation with mean of 13 (SD 4.8; 95% CI 12-14) prompt-response pairs. We found an increase in PCC with a mean difference of 0.94 (SD 1.64; 95% CI 0.69-1.20; Cohen d=0.58) from 5.89 (95% CI 5.55-6.23; scale 0-10) before the conversation to 6.83 (95% CI 6.55-7.12) after the conversation across 4 different patient role prompts. Furthermore, we found participants rating AI feedback of their conversation to be useful (mean 7.92, SD 1.61; 95% CI 7.67-8.17; scale 0-10), but feedback adequacy did not correspond to PCC increase (r=0.08; P=.32). CONCLUSIONS: Our results demonstrate how role-prompted GPT increases self-assessed communication competencies, introducing a novel tool for teaching relational learning. Our results present a starting point for using AI in education, particularly teaching communication in professional roles. On the basis of our findings in medical education, we anticipate further studies to investigate conversational training between lawyers and clients, marketers and customers, or managers and employees. Our research thus has implications for any field with a need for conversational training and relational learning.
14 June 2026
Read appraisal →JMIR medical education
Exploring the Feasibility of an Examiner-Worn Neck-Mounted Camera for Objective Structured Clinical Examination Assessment: Pilot Feasibility Study
BACKGROUND: The Objective Structured Clinical Examination (OSCE) is a prevalent method for evaluating clinical competence in medical education. As OSCEs become increasingly standardized and resource intensive, alternative evaluation methods are being explored, particularly because of the limited availability of certified examiners. However, few studies have investigated whether wearable technologies can support OSCE assessment. Wearable devices may provide a means of recording clinical skills from the examiner's perspective. OBJECTIVE: This pilot study, conducted in 2024, aimed to investigate the feasibility of using an examiner-worn neck-mounted camera for recording OSCE scenarios and to evaluate the evaluability of clinical performance from the recorded footage. METHODS: In total, 9 experienced medical educators participated in a simulated OSCE scenario involving electrocardiogram lead placement. All participants completed the initial live assessment and the postuse questionnaire, while 8 of 9 (89%) participants completed the subsequent video-based reassessment. Video recordings from both a fixed camera and a neck-mounted camera (THINKLET) were used to assess the evaluability of each OSCE item. Following a washout period, evaluators reassessed the neck-mounted camera recordings by using the original checklist, while fixed-camera recordings were used to judge the evaluability of each item. Agreement between live and video-based scoring was analyzed using percent agreement and the Cohen κ coefficient. A postevaluation questionnaire captured evaluators' experiences with the wearable device. RESULTS: Cohen κ ranged from 0.258 to 0.913 (mean 0.67, SD 0.20). Across checklist observations, more items were judged to be evaluable in the neck-mounted camera recordings than in the fixed-camera recordings, particularly for tasks requiring observation of fine motor skills. Evaluators reported generally positive experiences with the device, although some noted issues related to audio quality, comfort, posture restriction, and limited visibility at low angles. CONCLUSIONS: Although further investigation is needed, this pilot study suggests that an examiner-worn neck-mounted camera may be a valuable supplementary assessment tool for selected OSCE tasks. Further work is needed to refine the device, standardize recording protocols, and clarify how it can best support review and verification alongside live evaluation.
29 May 2026
Read appraisal →JMIR nursing
Simulation-Based Training for Nursing Students to Improve Patient Safety: Systematic Review
BACKGROUND: Patient safety is a fundamental pillar of health care quality. Simulation-based training provides a controlled environment for nursing students to develop safety competencies and error-recognition skills before clinical practice. OBJECTIVE: This systematic review aimed to describe and characterize the simulation-based education features and modalities used to address patient safety outcomes in undergraduate nursing students, identifying the strategies that contribute to improvements in safety-related competencies. METHODS: A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines across PubMed, Web of Science, Scopus, CINAHL, Cochrane, and Lilacs (2019-2024). Inclusion criteria focused on original studies involving undergraduate nursing students and simulation interventions measuring patient safety outcomes. Studies in languages other than English, Spanish, or Portuguese were excluded. Two reviewers independently performed study selection and data extraction. Methodological quality was assessed using Joanna Briggs Institute tools, applying a 60% quality threshold for inclusion. Results were synthesized through a narrative approach. RESULTS: A total of 20 studies from 12 countries were included. The methodological quality was high (n=14) and moderate (n=6). Findings revealed that high-fidelity simulation and virtual reality are the primary strategies used. Simulation proved effective in enhancing both technical skills (medication administration accuracy) and nontechnical skills (communication via SBAR [Situation, Background, Assessment, Recommendation] and ISBAR [Identification, Situation, Background, Assessment, Recommendation] tools, teamwork, and adverse event reporting). Key strategies contributing to safety included repetitive practice and interprofessional simulation, which significantly improved error detection and clinical judgment. CONCLUSIONS: Simulation is an essential pedagogical strategy for preparing nursing students to deliver safe care. Practical implications include the need to integrate structured simulation into nursing curricula to bridge the theory-practice gap. Future research should prioritize longitudinal designs to assess the retention of these safety skills in clinical settings and develop standardized metrics for measuring patient safety outcomes.
28 May 2026
Read appraisal →Scientific reports
3D‑printed training model for periodontal splinting: a randomized preclinical study
Preclinical simulation is essential for students to practice before clinical treatment. A low-cost 3D-printed model was developed with repositionable mobile maxillary anterior teeth to train periodontal splinting and evaluate learner perception and repositioning accuracy. In a two-period randomized cross-over course 43 students in their fourth year completed two palatal slot splints from the right to the left maxillary canine (FDI 13-23) in randomized material order. They used a polyethylene ribbon and a pre-impregnated unidirectional glass-fibre bundle. Outcomes included an electronic questionnaire using an anchored 6‑point ordinal scale from 1 for "Excellent" to 6 for "Unsatisfactory" following the German school grading system and geometric deviation of each tooth to an ideal position. The course was rated overall as good (Md 2.0, IQR 1.0) and highly clinically relevant (Md 1.0, IQR 1.0). Self-reported preparedness for splinting improved from poor (Md 5.0, IQR 1.0) before the course to good (Md 2.0, IQR 1.0; p < 0.001) after the course. In this pilot study, no statistically detectable positional deviations between materials or between the first and second session in this cohort were observed. This inexpensive, reproducible 3D-printed model enables realistic periodontal splinting training under simulated mobility conditions and may support structured preparation for clinical teaching.
25 May 2026
Read appraisal →JMIR formative research
Metaverse-Based Virtual Reality for Remote Anatomy Education: Pilot Randomized Controlled Trial
BACKGROUND: Traditional anatomy teaching relies on cadaveric dissection and 2D resources, which often require in-person attendance and may limit spatial understanding. Virtual reality (VR) provides an immersive, remote alternative that supports 3D visualization from home. Recent evidence suggests that while VR may yield comparable factual knowledge gains to 2D methods, its primary value lies in enhancing learner engagement, motivation, and perceived educational value. OBJECTIVE: This pilot randomized controlled trial compares remote synchronized VR with didactic animated anatomy lectures for the teaching of tracheostomy anatomy. METHODS: Participants were recruited via convenience sampling through the VRiMS (Virtual Reality in Medicine and Surgery) Surgical Society network. All participants first attended a synchronous 20-minute online lecture delivered by a consultant surgeon. They were then individually randomized to one of 2 groups using a computer-generated sequence. Allocation was concealed until the intervention; however, participants and researchers were unblinded. The intervention group completed a 10-minute metaverse-based VR session, delivered by a consultant surgeon via 3D Organon's Medverse platform on the PICO 4 Ultra headset. The control group completed a 10-minute prerecorded 2D animated lecture, accessed on their personal device. Participants then swapped to the other modality. Data were collected via Google Forms at 3 intervals (baseline, postintervention, and postcrossover) to assess confidence, spatial understanding, and knowledge (10-item multiple-choice questions). The analysis of nonparametric data utilized Wilcoxon signed-rank tests for within-group changes and Mann-Whitney U tests for between-group differences. RESULTS: Twenty-four medical students from 11 United Kingdom and Irish medical schools participated. Adherence was 100%, with all participants completing their assigned 10-minute intervention and all assessment points. Ninety-two percent of participants (n=22) reported no prior tracheostomy anatomy teaching. Additionally, 83% (n=20) had no prior remote-synchronized VR anatomy teaching experience. Anatomical confidence improved significantly in the VR group compared with animation (mean change 1.58, SD 1.00 vs mean 0.50, SD 0.80, P=.01). Knowledge scores improved significantly in both groups (VR: mean 1.75, SD 1.54, P=.007; animation: mean 2.83, SD 1.70, P=.003), with no significant postintervention difference between groups (P=.46). VR participants reported significantly superior spatial understanding across all measured domains (all P≤.009). These included depth perception (3.75 vs 2.58, P=.009), appreciation of anatomy from different viewpoints (4.25 vs 2.33, P=.001), mental reconstruction from varying angles (3.83 vs 2.08, P=.002), and spatial depth supporting anatomical understanding (4.08 vs 2.08, P=.001). Following the completion of both modalities, participants rated VR as more engaging (mean 4.54, SD 0.78) and more educationally effective (mean 4.29, SD 0.95) than animation. CONCLUSIONS: Remote VR teaching is feasible and engaging and enhances spatial understanding compared to animation. While knowledge gains were comparable between modalities, VR improved learner confidence and perceived 3D comprehension. Hence, VR may represent a scalable adjunct or alternative to traditional anatomy teaching.
20 May 2026
Read appraisal →JMIR medical education
Developing and Validating a Coding Scheme for Clinical Reasoning in History Taking Using Generative AI-Based Virtual Patients: Systematic Text Condensation Approach
BACKGROUND: Effective history taking helps clinicians identify key symptoms and form accurate hypotheses. Generative artificial intelligence (GenAI)-based virtual patients (VPs) are increasingly used to simulate and practice history taking. However, there is currently no straightforward approach to effectively identify students' clinical reasoning activities during these interactions, which limits the ability to provide instructional feedback. OBJECTIVE: This study aims to develop and validate a coding scheme to identify medical students' history-taking behaviors during interactions with GenAI-based VPs. METHODS: Second-year medical students (N=210) participated in 5 history-taking cases with GenAI-based VPs, yielding 1030 dialogues. Researchers applied the systematic text condensation method to these dialogue data from cases 1 to 4 to inductively develop a coding scheme and validate coding consistency. Subsequently, the dialogue data from case 5 were used to assess the correlation between the students' history-taking behaviors and their academic performance, including diagnostic accuracy, history-taking checklist scores, clinical knowledge test scores, and postencounter form scores. RESULTS: A coding scheme comprising 12 behaviors across 3 dimensions-clinical reasoning behaviors, information gathering behaviors, and social interaction behaviors-was developed with high interrater reliability (κ≥0.85). The correlation analysis revealed that key clinical reasoning behaviors, such as summarizing and integrating and logical organization, showed significant positive correlations with multiple performance metrics, underscoring their importance in fostering clinical competence. In contrast, information gathering behaviors such as specifying symptoms and routine question were associated with clinical knowledge and thoroughness of history taking but were less predictive of diagnostic accuracy. CONCLUSIONS: This study developed a reliable, theory-informed coding scheme that can identify students' questioning behaviors during history taking with GenAI-based VPs. The scheme effectively captures higher-order cognitive strategies and provides valuable insights into the development of clinical reasoning in medical students. This approach offers a scalable and efficient way to integrate real-time feedback into future medical education, fostering personalized learning and advancing competency-based assessments in clinical training.
14 Apr 2026
Read appraisal →Games for health journal
The Effect of Emergency Escape Room Simulation on Knowledge, Anxiety, and Satisfaction Levels of Students: A Randomized Controlled Trial
BACKGROUND: The aim of this study is to determine the effect of escape room simulation intervention on the knowledge, anxiety, and satisfaction levels of students in emergency nursing education. METHODS: This randomized controlled study was conducted with 40 students studying at the nursing faculty of a university in Istanbul. The students in the intervention group (n = 20) were given an escape room simulation intervention related to emergency nursing education. The students in the control group (n = 20) were not given any intervention other than the traditional education method. Data were collected using the Knowledge Test, State Anxiety Scale, and Visual Analog Scale for satisfaction. RESULTS: The knowledge level of the students in the intervention group measured immediately after the education (P = 0.003), 1 week after the education (P < 0.001), and 1 month after the education (P < 0.001) was found to be significantly higher than that of the control group. While no significant difference was found in anxiety levels before and after the education between the groups, a significant difference was found in anxiety levels before and after the training in the intervention group (P < 0.001). The satisfaction level measured immediately after the education was found to be significantly higher in the intervention group than in the control group (P < 0.001). CONCLUSION: This study show that escape room simulation increased emergency nursing knowledge and satisfaction and reduced anxiety levels of the students. It is recommended that escape room simulation intervention be used in more studies in nursing education. The study was registered on ClinicalTrials.gov.tr with the number NCT06619119.
11 Apr 2026
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