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Introduction: Formative assessments have overall been shown to improve summative evaluations in medical education. However, it remains unclear if utilizing them for course credit in an integrated curriculum over multiple subspecialties is beneficial for student acquisition of knowledge. We set out to determine if grading formative quizzes had an effect on student acquisition of knowledge via summative assessments. Materials and Methods: In 2020, quizzes remained mandatory, but were not graded for course credit. We collected and compared formative (quiz) and summative (unit exam) score data from student cohorts when quizzes were graded versus not graded. Medical college admission test (MCAT) score, gender, and underrepresented in medicine (URM) status data were utilized to determine if they had effects on outcomes. We used a predefined region of indifference (± 5%) and second-generation p-values to determine if there were meaningful differences in average summative exam scores. Results: Despite a drop in quiz scores after removing course credit, differences in average summative exam scores fully resided within the region of indifference for three of five course blocks, indicating no meaningful differences in summative exam scores existed for those blocks. In other blocks, the difference was not fully nested within the region of indifference; however, all data overlapped with this region, implying exam score differences were inconclusive for these blocks. Conclusions: Our study demonstrates that there is either no meaningful effect on summative assessments or no conclusive detrimental effects when mandatory quizzes are not graded for course credit.

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Before colonization, Aboriginal and Torres Strait Islander communities had nurturing, holistic, and communitarian approaches that promoted extended and healthy lives for their children. Colonization, marked by policies of genocide and assimilation, has resulted in an alarming overrepresentation of Aboriginal and Torres Strait Islander children under the care of child protection agencies, resulting in compromised health outcomes and reduced life expectancies. We are conducting a study designed to enhance positive developmental outcomes for Aboriginal and Torres Strait Islander children by articulating and enabling the rights of mothers and children to breastfeed in the context of a child protection intervention and child removal. To understand and address this problem, it is critical to implement culturally safe, de-colonized, emancipatory research that is guided by and benefits Aboriginal and Torres Strait Islander communities. This article presents an emancipatory framework that we are applying to our study using an Aboriginal participatory action research approach, that serves as a guide for non-Indigenous researchers seeking to conduct research with Indigenous communities. We emphasize the importance of incorporating an Aboriginal participatory action research framework, using community consultation and codesign; culturally secure data collection methods, and paying attention to Indigenous data sovereignty. Developing trusting respectful relationships is conducive to knowledge acquisition, exchange, and use, when research approaches deeply rooted in community involvement are applied. A call to action by the critical midwifery studies collective, urges non-Indigenous researchers to become accountable allies that demonstrates respect for community leadership while actively striving to ensure research does not perpetuate further harm, and produces effective change. This article provides an overview of ways to conduct ethical emancipatory research with Indigenous participants, that is, of benefit to midwifery practitioners and is applicable to many areas of research, policy, and practice.

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BACKGROUND: Artificial intelligence (AI) can be a tool in the diagnosis and acquisition of knowledge, particularly in dentistry, sparking debates on its application in clinical decision-making. OBJECTIVE: This study aims to evaluate the accuracy, completeness, and reliability of the responses generated by Chatbot Generative Pre-Trained Transformer (ChatGPT) 3.5 in dentistry using expert-formulated questions. MATERIALS AND METHODS: Experts were invited to create three questions, answers, and respective references according to specialized fields of activity. The Likert scale was used to evaluate agreement levels between experts and ChatGPT responses. Statistical analysis compared descriptive and binary question groups in terms of accuracy and completeness. Questions with low accuracy underwent re-evaluation, and subsequent responses were compared for improvement. The Wilcoxon test was utilized (α = 0.05). RESULTS: Ten experts across six dental specialties generated 30 binary and descriptive dental questions and references. The accuracy score had a median of 5.50 and a mean of 4.17. For completeness, the median was 2.00 and the mean was 2.07. No difference was observed between descriptive and binary responses for accuracy and completeness. However, re-evaluated responses showed a significant improvement with a significant difference in accuracy (median 5.50 vs. 6.00; mean 4.17 vs. 4.80; p=0.042) and completeness (median 2.0 vs. 2.0; mean 2.07 vs. 2.30; p=0.011). References were more incorrect than correct, with no differences between descriptive and binary questions. CONCLUSIONS: ChatGPT initially demonstrated good accuracy and completeness, which was further improved with machine learning (ML) over time. However, some inaccurate answers and references persisted. Human critical discernment continues to be essential to facing complex clinical cases and advancing theoretical knowledge and evidence-based practice.

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Deep learning from collaboration occurs if the learner enacts interactive activities in the sense of leveraging the knowledge externalized by co-learners as resource for own inferencing processes and if these interactive activities in turn promote the learner's deep comprehension outcomes. This experimental study investigates whether inducing dyad members to enact constructive preparation activities can promote deep learning from subsequent collaboration while examining prior knowledge as moderator. In a digital collaborative learning environment, 122 non-expert university students assigned to 61 dyads studied a text about the human circulatory system and then prepared individually for collaboration according to their experimental conditions: the preparation tasks varied across dyads with respect to their generativity, that is, the degree to which they required the learners to enact constructive activities (note-taking, compare-contrast, or explanation). After externalizing their answer to the task, learners in all conditions inspected their partner's externalization and then jointly discussed their text understanding via chat. Results showed that more rather than less generative tasks fostered constructive preparation but not interactive collaboration activities or deep comprehension outcomes. Moderated mediation analyses considering actor and partner effects indicated the indirect effects of constructive preparation activities on deep comprehension outcomes via interactive activities to depend on prior knowledge: when own prior knowledge was relatively low, self-performed but not partner-performed constructive preparation activities were beneficial. When own prior knowledge was relatively high, partner-performed constructive preparation activities were conducive while one's own were ineffective or even detrimental. Given these differential effects, suggestions are made for optimizing the instructional design around generative preparation tasks to streamline the effectiveness of constructive preparation activities for deep learning from digital collaboration.

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BACKGROUND: We investigated the potential of an imaging-aware GPT-4-based chatbot in providing diagnoses based on imaging descriptions of abdominal pathologies. METHODS: Utilizing zero-shot learning via the LlamaIndex framework, GPT-4 was enhanced using the 96 documents from the Radiographics Top 10 Reading List on gastrointestinal imaging, creating a gastrointestinal imaging-aware chatbot (GIA-CB). To assess its diagnostic capability, 50 cases on a variety of abdominal pathologies were created, comprising radiological findings in fluoroscopy, MRI, and CT. We compared the GIA-CB to the generic GPT-4 chatbot (g-CB) in providing the primary and 2 additional differential diagnoses, using interpretations from senior-level radiologists as ground truth. The trustworthiness of the GIA-CB was evaluated by investigating the source documents as provided by the knowledge-retrieval mechanism. Mann-Whitney U test was employed. RESULTS: The GIA-CB demonstrated a high capability to identify the most appropriate differential diagnosis in 39/50 cases (78%), significantly surpassing the g-CB in 27/50 cases (54%) (p = 0.006). Notably, the GIA-CB offered the primary differential in the top 3 differential diagnoses in 45/50 cases (90%) versus g-CB with 37/50 cases (74%) (p = 0.022) and always with appropriate explanations. The median response time was 29.8 s for GIA-CB and 15.7 s for g-CB, and the mean cost per case was $0.15 and $0.02, respectively. CONCLUSIONS: The GIA-CB not only provided an accurate diagnosis for gastrointestinal pathologies, but also direct access to source documents, providing insight into the decision-making process, a step towards trustworthy and explainable AI. Integrating context-specific data into AI models can support evidence-based clinical decision-making. RELEVANCE STATEMENT: A context-aware GPT-4 chatbot demonstrates high accuracy in providing differential diagnoses based on imaging descriptions, surpassing the generic GPT-4. It provided formulated rationale and source excerpts supporting the diagnoses, thus enhancing trustworthy decision-support. KEY POINTS: • Knowledge retrieval enhances differential diagnoses in a gastrointestinal imaging-aware chatbot (GIA-CB). • GIA-CB outperformed the generic counterpart, providing formulated rationale and source excerpts. • GIA-CB has the potential to pave the way for AI-assisted decision support systems.

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OBJECTIVES: This umbrella review aimed to consolidate the evidence base on the impact of high-fidelity simulation on knowledge and performance among undergraduate nursing students. DESIGN: Umbrella review with meta-analyses of pooled effect sizes, followed by an additional meta-analysis of primary studies from the included systematic reviews, excluding overlapping results. DATA SOURCES: Systematic searches were performed up to August 2023 in PubMed, Embase, and Cochrane Library. We included reviews that compared high-fidelity simulation against other learning strategies. REVIEW METHODS: The risk of bias was assessed for each included systematic review (ROBIS tool) and primary study (RoB 2 or ROBINS-I as appropriate). Random-effect meta-analyses of meta-analyses were performed to estimate the pooled effects of high-fidelity simulation on knowledge and performance. Further random-effect meta-analyses of primary studies were conducted, with overlapping studies excluded (12 %). Subgroup analyses were performed to provide a more comprehensive analysis of the findings. Trim-and-fill analyses were conducted to adjust for potential publication bias. RESULTS: Six systematic reviews were included and encompassed 133 primary studies (2767 and 3231 participants concerning performance and knowledge, respectively). The adjusted pooled effects for knowledge (SMD = 0.877, 95 % CI: 0.182 to 1.572) and performance (SMD = 0.738, 95 % CI: 0.466 to 1.010) closely aligned with those obtained from meta-analyzing the primary studies for knowledge (SMD = 0.980) and performance (SMD = 0.540), both showing high statistical heterogeneity. Traditional lectures represented the more common comparison. The subgroup analysis revealed significant differences in effect sizes across geographic locations, topics, types of control, and how interventions were reported. CONCLUSIONS: The results provide robust evidence supporting the integration of high-fidelity simulation into undergraduate nursing programs to enhance students' knowledge and performance. The high reported heterogeneity may be attributed to variations in study contexts or methodologies. Future research should explore the optimal use of high-fidelity simulation in different educational and cultural contexts.

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The rapid proliferation and integration of AI chatbots in office environments, specifically the advanced AI model ChatGPT, prompts an examination of how its features and updates impact knowledge processes, satisfaction, and word-of-mouth (WOM) among office workers. This study investigates the determinants of WOM among office workers who are users of ChatGPT. We adopted a quantitative approach, utilizing a stratified random sampling technique to collect data from a diverse group of office workers experienced in using ChatGPT. The hypotheses were rigorously tested through Structural Equation Modeling (SEM) using the SmartPLS 4. The results revealed that system updates, memorability, and non-language barrier attributes of ChatGPT significantly enhanced knowledge acquisition and application. Additionally, the human-like personality traits of ChatGPT significantly increased both utilitarian value and satisfaction. Furthermore, the study showed that knowledge acquisition and application led to a significant increase in utilitarian value and satisfaction, which subsequently increased WOM. Age had a positive influence on WOM, while gender had no significant impact. The findings provide theoretical contributions by expanding our understanding of AI chatbots' role in knowledge processes, satisfaction, and WOM, particularly among office workers.

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Background: Culture is an essential component that governs all aspects of human behavior. Superstition is an irrational belief observed in almost all cultures. It is linked to one or more factors like supernatural powers, good luck, bad omen, fiction, illegitimate activity, absurd narration, folk tales, or practice without any rational basis. Methods: A cross-sectional social experiment was conducted to evaluate the effect of cultural appropriation as a tool to enhance medical knowledge acquisition and attitudinal development in medical education. The experiment was designed to target a non-medical population. Four superstition-oriented videos were developed with 20 scientific pieces of information related to forensic medicine. A data collection sheet was developed on Microsoft form with 16 questions was distributed on the participants. Results: Out of the 986 participants, 763 (77.5%) watched the whole set of videos. About 55-95% of responders demonstrated knowledge acquisition of all the questions. There was a statistically significant difference between those who watched the videos and those who did not. When participants were asked about the most important information they remember from the videos, their answers fell into two main categories; information related to core scientific knowledge (80% of participants) and information not related to the core knowledge (16% of respondents). The top three areas for the reasons why people wanted to watch the videos were curiosity, knowledge, and career. A change in attitudes was reported among the participants where 80% of responders demonstrated curiosity to know more about this world, 46% responders reported developing more respect for the forensic physician and 43% revealed their ignorance about this great hidden world. Conclusion: Cultural appropriation could be a needed strategy to accommodate for upscale in education. Learners might validate that learning happens through a door that adopts not only honours their culture and adapts to it.

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Practical training stands as a crucial component in shaping pharmacy students, bridging the gap between classroom-based theoretical knowledge and its application in real-world contexts. This study investigates the correlation between the satisfaction levels experienced during practical training and the acquisition of knowledge, particularly focusing on drug names. Drawing from the National DataBase (NDB) open data provided by Japan's Ministry of Health, Labour and Welfare, a survey centered on the top 100 dispensed drugs was crafted. A correlation analysis was conducted between the satisfaction scores gathered from students and their depth of knowledge on drug names. Intriguingly, despite observing a significantly high satisfaction level during the practical training, there was no marked correlation between this satisfaction and the proficiency in recalling drug names after the training. Furthermore, the volume of daily prescriptions handled did not significantly impact this knowledge. The findings underscore the notion that high satisfaction during training does not necessarily guarantee a thorough understanding of the subject matter. This sheds light on the importance of not solely relying on satisfaction metrics in training programs and ensuring a holistic, in-depth educational approach.

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AIMS AND OBJECTIVES: This paper aims to inform nursing and other healthcare disciplines by clearly defining patient competence and the skills required to improve self-care behaviours. BACKGROUND: Competence has been defined in education and leadership. However, competence in persons with chronic disease has not been expanded upon since one publication in 1983. Patient competence needs to be developed and defined so that healthcare disciplines can understand the attributes necessary for a patient to be deemed competent to promote self-care behaviours. DESIGN: A concept derivation. METHODS: Walker and Avant's approach to concept derivation was used to identify a base concept (competence) that is well-defined in another field, define the concepts associated with the parent field, and transpose that definition to a new field to formulate a redefined concept. PsycINFO, Scopus, Web of Science and Medline were searched, and 21 articles were included. RESULTS: Patient competence is defined as the ability of a person with a chronic illness to reach skill mastery, achieve knowledge, maintain a positive attitude and develop trust in themselves and in healthcare providers that will facilitate active engagement to improve self-care behaviours. CONCLUSIONS: Defining patient competence is important in assisting nurses and other healthcare providers in understanding the attributes needed to deem a patient competent, especially those living with chronic illnesses requiring lifelong self-care behaviours. More research is needed to aid in the designing of a precise instrument for measuring this phenomenon. RELEVANCE TO CLINICAL PRACTICE: Concept derivation of patient competence provides a framework for nurses and other members of the healthcare profession to understand the attributes needed to determine patient competence.

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Introduction: Higher educational institutions increasingly focus on incorporating games to enhance student engagement. Gimkit is a recent addition to gamified learning that allows instructors to create quiz games with randomly repeated questions. Case description: The study of nutrition requires memorization of facts. Gimkit was incorporated into a dental hygiene class to teach nutrition and support rote learning. Anonymous data on student performance and satisfaction were collected. Descriptive statistics were applied to summarize the survey results; the difficulty and discrimination indices were analyzed to evaluate students' academic performance. Results: Ten percent of the class participated in the voluntary survey; academic performance was analyzed for the whole class. The study identified Gimkit as a potential learning tool, especially for content areas that require memorization and learning of facts. Conclusion: Data show a positive impact of in-class gaming on knowledge acquisition and retention.

Introduction: Les établissements d'enseignement supérieur se concentrent de plus en plus sur l'intégration de jeux pour renforcer l'engagement des étudiants. Gimkit est un ajout récent à l'éventail d'outils d'apprentissage ludique qui permet aux instructeurs de créer des jeux-questionnaires avec des questions répétées au hasard. Description de cas: L'étude de la nutrition nécessite de mémoriser des faits. Gimkit a été intégré à un cours d'hygiène dentaire pour enseigner la nutrition et favoriser l'apprentissage par mémorisation. On a recueilli des données anonymes sur les résultats et la satisfaction des élèves. On a eu recours à des méthodes de statistique descriptive pour résumer les résultats du sondage; les indices de difficulté et de discrimination ont été analysés pour évaluer le rendement universitaire des étudiants. Résultats: Dix pour cent des étudiants qui suivaient le cours ont répondu à ce sondage facultatif; on a analysé le rendement universitaire de l'ensemble de la classe. L'étude a établi que Gimkit était un outil d'apprentissage potentiel, en particulier dans les domaines qui nécessitent l'apprentissage et la mémorisation de faits. Conclusion: Les données montrent une incidence positive de l'utilisation des jeux dans le cadre du cours sur l'acquisition et la rétention des connaissances.

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The purpose of our study was to determine if knowledge acquisition, as measured by exam item performance, differed for active or passive learning activities in our medical curriculum. Additionally, we looked for differences in exam item performance in one second-year course that varies the method of an active learning activity, case-based collaborative learning (CBCL). Finally, we assessed whether item performance was impacted when small group activities were conducted online due to the COVID-19 pandemic. Exam item difficulty values were collected for several years of lectures, flipped classroom, and CBCL. Statistical analysis and modeling of data were performed to identify differences in difficulty of exam items that assess content delivered by different learning activities. Our analysis revealed no differences in difficulty of exam items that assess content delivered by different learning activities. Similarly, we determined that varying the execution of CBCL in one course did not impact exam item performance. Finally, moving CBCL small group sessions online did not impact exam item difficulty. However, we did detect a minor reduction in overall exam scores for the period of online instruction. Our results indicate that knowledge acquisition, as assessed by our multiple-choice summative exams, was equivalent regardless of learning activity modality. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01842-8.

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PURPOSE: To determine if a consumer co-designed infographic increased knowledge of physical activity and self-efficacy for exercise after total knee joint replacement surgery. METHODS: Forty-four adults with primary knee joint replacement surgery were recruited from a public and a private hospital in Melbourne, Australia. Participants were randomly allocated to an experimental or control group. The experimental group received a consumer co-designed infographic. All participants received usual care. Primary outcome measures were knowledge of physical activity and self-efficacy for exercise. Outcomes were administered at baseline, week 1 and week 6. Semi-structured interviews with experimental group participants explored the acceptability, implementation and efficacy of the infographic. RESULTS: There were no between-group differences for knowledge of physical activity at week 1 (MD -0.02 units, 95% CI -0.9 to 0.9) or week 6 (MD 0.01 units, 95% CI -0.9 to 0.9). Self-efficacy for exercise increased at week 1 (MD 14.2 units, 95% CI 2.9-25.4) but was not sustained. Qualitative data showed that the infographic was embraced by some participants but not by others. CONCLUSIONS: A consumer co-designed infographic did not improve knowledge of physical activity but may have had a short-term positive effect on self-efficacy for exercise after knee joint replacement. Trial registration ACTRN12621000910808.

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Purpose: We conducted a pilot survey among young adults attending a suburban Canadian university to understand: (1) knowledge of the 2019 Canada's Food Guide (CFG); (2) self-reported food choices and eating habits; (3) perceived influence of the CFG on food choices and eating habits; and (4) suggestions to improve engagement with CFG.Methods: Students were recruited, through posts on social media platforms, to complete an online questionnaire between 7 March and 6 April 2020.Results: One-hundred and twenty-one (70% women) students responded. One-third (33%) of women and 8% of men reported consuming the recommended proportion of vegetables and fruits (i.e., 40%-60% of the plate) at their most recent meal (P = 0.001). Men were more likely to report overconsuming protein foods than women (58% vs 32%, P = 0.005). The perceived influence of the CFG on food choices and eating habits was low, with a mean score 2.2 ± 1.4 out of 7, with 7 indicating "highly influential." Over 92% of participants believed awareness of the CFG could be improved through social media platforms.Conclusions: Although half of the participants correctly answered all 8 questions that assessed knowledge of the CFG, there is an opportunity for dietitians and related health professionals to improve engagement with CFG.

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Knowledge management in higher education aims to increase the effectiveness of knowledge and intellectual capital by accomplishing three main goals: increasing task quality and efficiency, training human resources at all levels of operation, and expanding an organization's field knowledge base. This data's purpose was to shed light on how knowledge management influences the enthusiasm of university professors and their sense of job satisfaction. Knowledge acquisition, knowledge dissemination, and utilization are the three pillars of knowledge management systems that contribute to higher levels of academic staff's teaching motivation and satisfaction. A self-administered questionnaire collected this data from 676 academics in Vietnam. Knowledge management system improvements can be based on data analysis to improve faculty happiness and enthusiasm for academic staff in Higher Education Institutions.

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BACKGROUND: A majority of dental school students do not undergo hands-on clinical training in implantology in the undergraduate curriculum. Training is usually restricted to pre-implant evaluation and post-implant prostheses. Virtual implant planning software (VIPS) provides an alternative opportunity for undergraduate students to experience implant planning much before gaining hands-on experience. However, not many studies have the contribution of VIPS to the knowledge acquisition of students. We conducted a preliminary study to evaluate the knowledge acquisition of the students when exposed to a hands-on session of VIPS. We also evaluated students' satisfaction levels, when exposed to hands-on training in fully guided implant planning software. METHODS: A two-part theory lecture on fully guided implant planning was delivered to 90, 5th (final)-year dental undergraduate students by the oral radiology faculty. The students were then randomly divided into three groups. Group A was exposed to didactic lectures only. Group B was shown a video for fully guided implant planning in addition to the didactic lecture. Group C was shown a video for fully guided implant planning in addition to a didactic lecture and then performed a hands-on session of virtual implant planning under faculty guidance. Students from all groups were given an MCQ-based test. After the completion of the test students from group A and B also received VIPS hands-on training. Students from all three groups answered and a feedback questionnaire regarding their satisfaction levels with VIPS. RESULTS: The overall test score of students in Group C was higher than their colleagues in both Groups A and B and the differences were statistically significant (p = 0.01). More than 85% of the students were satisfied with the teaching approach. CONCLUSIONS: The utilization of VIPS in the training of dental undergraduate students improves their performance confirming better knowledge acquisition and content mastery.

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Background: Traumatic brain injury (TBI) outcomes are dependent on patients' biological sex (e.g., hormone levels) and sociocultural gender (e.g., norms, responsibilities). Informal caregivers additionally experience disruptions to identity and roles post-TBI. However, information on this topic remains largely unavailable to patients and caregivers. Purpose: This study aimed to determine the effectiveness of a one-time educational intervention on sex and gender influences in TBI for patients and informal caregivers. Materials and methods: We conducted a pilot pre-test/post-test randomized control-group design study. Groups (i.e., passive, active and control) consisted a total of 16 persons with TBI and caregivers (75% persons with TBI, 63% women). Individual and group learning gains, and group-average normalized gain, were computed for three learning domains: knowledge, attitude, and skill. An intervention with an average normalized gain of ≥30% was considered effective. Educational intervention evaluation and qualitative comments post-participation were summarized. Results: The passive group demonstrated the highest average normalized gain across the three learning domains, including 100% for knowledge, 40% and 61% for attitude, and 37% for skill. The remaining groups did not reach an average normalized gain of ≥30%, except for the attitude domain of the control group (33% and 32%). Two key categories were identified qualitatively: (1) gendered self-expectations post-injury and (2) implications of gender stereotypes in rehabilitation, including the need for rehabilitation treatment to look beyond sex and gender. The post-participation educational session evaluation conveyed high appraisal of content, organization, and usability of the intervention. Conclusion: A one-time passive educational intervention on sex and gender in TBI may improve knowledge, attitude, and skill on the topic of sex and gender among adults with TBI and caregivers. Obtaining knowledge and skill on sex and gender effects in TBI can potentially help persons with TBI and caregivers adapt to changes in roles and behaviours post-injury.

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Background: The advancement of digital technology implies the importance of polychronic learning. Since polychronicity is not equivalent to multitasking behavior, they need to be considered separately. However, less research has been explored on how polychronicity is related to multitasking behavior in the educational field. Objective: To explore the relationships among polychronicity, multitasking behavior and learning performance (including knowledge acquisition and learning satisfaction) in an online learning environment. Methods: The relationship among variables was analyzed from 865 responses obtained from a questionnaire survey, and independent sample t tests and SEM analysis were used to examine the research hypotheses. Results: College students showed a higher frequency of multitasking behavior, time tangibility and scheduling preference, and learning satisfaction in multitasking online learning environments than high school students. Additionally, college students were different from high school students on the paths of involvement with people to multitasking behavior (Δ χ 2= 5.42, p = 0.02) and scheduling preference to learning satisfaction (Δχ 2 = 9.54, p = 0.002). Conclusion: The relationship among polychronicity, multitasking behavior and perceived learning performance in an online learning environment varies by student educational stage.

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BACKGROUND: Digital cognitive behavioral therapy (CBT) interventions can effectively prevent and treat depression and anxiety, but engagement with these programs is often low. Although extensive research has evaluated program use as a proxy for engagement, the extent to which users acquire knowledge and enact skills from these programs has been largely overlooked. OBJECTIVE: This study aimed to investigate how skill enactment and knowledge acquisition have been measured, evaluate postintervention changes in skill enactment and knowledge acquisition, examine whether mental health outcomes are associated with skill enactment or knowledge acquisition, and evaluate predictors of skill enactment and knowledge acquisition. METHODS: PubMed, PsycINFO, and Cochrane CENTRAL were searched for randomized controlled trials (RCTs) published between January 2000 and July 2022. We included RCTs comparing digital CBT with any comparison group in adolescents or adults (aged ≥12 years) for anxiety or depression. Eligible studies reported quantitative measures of skill enactment or knowledge acquisition. The methodological quality of the studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for RCTs. Narrative synthesis was used to address the review questions. RESULTS: In total, 43 papers were included, of which 29 (67%) reported a skill enactment measure and 15 (35%) reported a knowledge acquisition measure. Skill enactment was typically operationalized as the frequency of enacting skills using the completion of in-program activities (ie, formal skill enactment; 13/29, 45%) and intervention-specific (9/29, 31%) or standardized (8/29, 28%) questionnaires. Knowledge measures included tests of CBT knowledge (6/15, 40%) or mental health literacy (5/15, 33%) and self-report questionnaires (6/15, 40%). In total, 17 studies evaluated postintervention changes in skill enactment or knowledge acquisition, and findings were mostly significant for skill enactment (6/8, 75% of the studies), CBT knowledge (6/6, 100%), and mental health literacy (4/5, 80%). Of the 12 studies that evaluated the association between skill enactment and postintervention mental health outcomes, most reported ≥1 significant positive finding on standardized questionnaires (4/4, 100%), formal skill enactment indicators (5/7, 71%), or intervention-specific questionnaires (1/1, 100%). None of the 4 studies that evaluated the association between knowledge acquisition and primary mental health outcomes reported significant results. A total of 13 studies investigated predictors of skill enactment; only type of guidance and improvements in psychological variables were associated with increased skill enactment in ≥2 analyses. Predictors of knowledge acquisition were evaluated in 2 studies. CONCLUSIONS: Digital CBT for depression and anxiety can improve skill enactment and knowledge acquisition. However, only skill enactment appears to be associated with mental health outcomes, which may depend on the type of measure examined. Additional research is needed to understand what types and levels of skill enactment and knowledge acquisition are most relevant for outcomes and identify predictors of these constructs. TRIAL REGISTRATION: PROSPERO CRD42021275270; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=275270.

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The fight against antibiotic resistance has become a true global public health challenge of gargantuan proportions. Amongst the myriad of approaches being explored to tackle this predicament, one strategy involves enhancing prescriber knowledge and in particular their basic knowledge of medical bacteriology. Yet, as we well know in medical microbiology teachings, traditional lectures can be arduous, attempting to cram in a vast array of information in a limited time. An alternative solution to improve student engagement and enhance learning outcomes is to utilize educational games in complementary approach. Such games are an effective means of inspiring students to learn, encouraging self-assessment, and injecting diversity into the teaching process. To this end, we have developed and evaluated an educational card game, the 'BacteriaGame,' aimed at our medical students in medical bacteriology. Designed for students at the basic level, it serves as activity at the end of their apprenticeship to their bacteriology education. Additionally, it can also be used as a review tool by more advanced students, with teachers able to impart additional knowledge as the game progresses. We also use it in continuous training of medical laboratory staff. In this study, we evaluated the game at various stages of medical education, collecting feedback and analysing its impact on knowledge acquisition, comparing it to traditional lectures. Feedback from the majority of students revealed that the rules were clear, the game was enjoyable, and neither too lengthy nor too challenging. The integration of 'BacteriaGame' into their future training piqued their interest. In terms of learning outcomes, we discovered a significant increase in knowledge acquisition among those who used the game (P < .05). 'BacteriaGame' is now published by the French Society of Microbiology (SFM) and distributed in all medical and pharmacy schools thanks to a funding of the French Health Ministry. An English edition of the game is also available for international use as a physical copy to be purchased from the SFM. This will allow a large-scale distribution to colleagues who would like to use this game in their teaching.

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