Staying Current Mechanisms in cardiovascular diseases: how useful are medical textbooks, eMedicine, and YouTube?
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Staying Current Mechanisms in cardiovascular diseases: how useful are medical textbooks, eMedicine, and YouTube?
Submitted 2 January 2014; accepted in final form 20 March 2014 Azer SA. Mechanisms in cardiovascular diseases: how useful are medical textbooks, eMedicine, and YouTube? Adv Physiol Educ 38: 124 –134, 2014; doi:10.1152/advan.00149.2013.—The aim of this study was to assess the contents of medical textbooks, eMedicine (Medscape) topics, and YouTube videos on cardiovascular mecha- nisms. Medical textbooks, eMedicine articles, and YouTube were searched for cardiovascular mechanisms. Using appraisal forms, copies of these resources and videos were evaluated independently by three assessors. Most textbooks were brief in explaining mech- anisms. Although the overall average percentage committed to cardiovascular mechanisms in physiology textbooks (n ϭ 7) was
16.1% and pathology textbooks (n ϭ 4) was 17.5%, there was less emphasis on mechanisms in most internal medicine textbooks (n ϭ 6), with a total average of 6.9%. In addition, flow diagrams explaining mechanisms were lacking. However, eMedicine topics (n ϭ 48) discussed mechanisms adequately in 22.9% (11 of 48) topics, and the percentage of content allocated to cardiovascular mechanisms was higher (15.8%, 46.2 of 292) compared with that of any internal medicine textbooks. Only 29 YouTube videos fulfilled the inclusion criteria. Of these, 16 YouTube were educa- tionally useful, scoring 14.1 Ϯ 0.5 (mean Ϯ SD). The remaining 13 videos were not educationally useful, scoring 6.1 Ϯ 1.7. The concordance between the assessors on applying the criteria mea- sured by score was in the range of 0.55– 0.96. In conclusion, despite the importance of mechanisms, most textbooks and You- Tube videos were deficient in cardiovascular mechanisms. eMedi- cine topics discussed cardiovascular mechanisms for some dis- eases, but there were no flow diagrams or multimedia explaining mechanisms. These deficiencies in learning resources could add to the challenges faced by students in understanding cardiovascular mechanisms. mechanisms; cardiovascular conditions; textbooks; eMedicine; You- Tube; basic sciences; pathogenesis; linking basic and clinical sci- ences; integration of knowledge CARDIOVASCULAR MECHANISMS are integral components in un- derstanding pathophysiological changes of diseases and in linking basic and clinical sciences in a meaningful way (20). They also enable learners to examine the etiology and contributing factors of cardiovascular diseases as well as the chain of changes caused by the disease processes at molec- ular, cellular, organ, and body system levels (7, 36). Car- diovascular mechanisms can also provide an explanation for the patient’s presenting symptoms and elicited clinical signs. Therefore, mechanisms represent a system of casualty outlining processes caused by a disease at its different stages and providing an explanation for the changes. Mechanisms could also accommodate not just basic sciences but also biopsychosocial and behavioral aspects related to cardiovas- cular diseases (7, 5, 30). Considering the educational outcomes obtained from learn- ing mechanisms of diseases, most medical curricula are en- forcing mechanisms in their teaching/learning approaches. For example, in problem-based learning (PBL), case-based learn- ing, task-based learning, and related activities, many schools have adopted mechanisms in their case template (22, 39). The educational outcomes that can be obtained from mechanisms include 1) enabling students to explain their hypotheses for the patient’s problems identified; 2) encouraging students to inte- grated knowledge from basic and clinical sciences as well as biopsychosocial issues in mechanisms; 3) stimulating students to explore pathophysiological changes at molecular, cellular, organ, and body system levels; and 4) using basic sciences to interpret patient’s symptoms, clinical signs, and the results of clinical investigations (5, 20, 36). With the introduction of integrated and self-regulated learn- ing to most medical schools such as PBL and case-based learning, medical students tend to use a range of learning resources such as Google, YouTube, and eMedicine (1, 2, 4, 6, 9, 22, 37). This does not necessarily mean a shift from using recommended or prescribed textbooks. Despite some limita- tions, textbooks remain one of the key learning resources, but most student rely, in addition, on online resources such as eMedicine and YouTube to enhance their understanding and consolidate the knowledge they need for their learning issues (14). eMedicine is one of the largest online clinical resources available to medical professionals, medical students, and the public. It comprises Ͼ6,800 articles, each of which is associ- ated with 1 of 62 clinical subspecialty textbooks (41). Also, eMedicine topics are authored by board-certified consultants, and the articles are peer reviewed by several experts to which the article belongs. YouTube is the largest internet video- sharing site and is a useful tool in social communication, advertising, and promoting learning resources to the public and students (19). Although a few studies have shown that You- Tube videos could be educationally useful, other studies have reported concerns about misleading information included in YouTube videos (4, 6, 25, 26). The aim of this research was to evaluate the usefulness of the learning resources commonly used by students including med- ical textbooks, eMedicine, and YouTube videos on cardiovas- cular mechanisms, with particular emphasis on the clarity, quality, and percentage of contents committed to cardiovascu- lar mechanisms. These resources were selected because they represent common resources used by medical students to pre- pare their learning issues. The research question for the study was as follows: how useful are medical textbooks, eMedicine (Medscape) topics, and YouTube videos in learning cardiovas- cular mechanisms? The focus was on the clarity, quality, and Address for reprint requests and other correspondence: S. A. Azer, Medical Education Dept., College of Medicine, King Saud Univ., PO Box 2925, Riyadh 11461, Saudi Arabia (e-mail: azer2000@optusnet.com.au).
doi:10.1152/advan.00149.2013. 124 1043-4046/14 Copyright © 2014 The American Physiological Society by 10.220.33.2 on February 5, 2017 http://advan.physiology.org/ Downloaded from
adequacy of contents of mechanisms provided in these re- sources.
METHODS Medical Textbooks Searching for textbooks. The aim of this search was to obtain a representative sample of textbooks in physiology, pathology, and internal medicine to describe the clarity and adequacy and if there were any deficiencies in the contents on mechanisms of cardiovascu- lar diseases. The Google Book search engine was used to search for textbooks covering human physiology, pathology, and internal med- icine. The terms used in the search were “physiology” and “human physiology,” “pathology,” and “internal medicine”. Textbooks in English published from 2007 onward were selected. Only textbooks intended for undergraduate medical students were included; textbooks written for specialties in physiology, pathology, internal medicine, or other health professionals were not included. Study guides or com- panion books were excluded. Additionally, the same search terms were used to search Amazon (http://www.amazon.com) and Barnes & Noble (http://www.barnesandnoble.com/) websites. Medical text- books on human physiology, pathology, and internal medicine were used in this study. These textbooks embodied a representative sample of undergraduate medical textbooks prescribed in these programs and comprise the following: 1) they are prescribed in most medical schools worldwide, 2) they are regularly updated and several editions have been produced over the years, 3) they are among the bestseller medical textbooks as per Amazon and the publishers’ websites, and 4) they are reviewed in prestigious medical journals such as the British Medical Journal, Journal of the American Medical Association, and New England Journal of Medicine. Evaluation tool. To standardize the evaluation of the information on mechanisms, quantity was calculated from the actual page content and percentage of content devoted to mechanisms, reflecting the commitment of the authors to provide learners with an adequate understanding of the topic (12). The percentages were calculated by dividing the actual page count by the total number of pages committed to cardiovascular diseases/topics and multiplying by 100. The total number of images and tables in each chapter were identified and counted. Images and tables explaining mechanisms/pathogenesis were counted, and the percentages were calculated by dividing the actual images or tables by the total number of images or tables in the chapter and multiplied by 100. The clarity, quality, and adequacy of mecha- nism contents were ranked using a scale of 1–3 (where 1 ϭ poor, 2 ϭ average, and 3 ϭ adequate/optimum level). Piloting the evaluation. The aim of piloting was to introduce the evaluators to the tool, ensure that they were able to use it, and identify any inconsistencies among the evaluators that might necessitate im- provement of the tool (44). Before the tool was applied, three chapters (other than those included in the study) were evaluated by the three evaluators for their content on mechanisms. The results from the three evaluators were placed on Excel sheets and were discussed in a meeting. Inconsistencies and areas that were difficult to assess were resolved through discussion until a final agreement was reached. The process was repeated by evaluating three other chapters, and the agreement between the evaluators was calculated again.
(7 textbooks on human physiology, 4 textbooks on pathology, and 6 textbooks on internal medicine) were committed to cardiovascular diseases/system and blood vessels. These chapters were evaluated by the three evaluators independently. The results from each evaluator were placed on Excel sheets. The findings were discussed among the evaluators. The agreement between the three evaluators was calcu- lated using Cohen’s interrater correlation.
on October 12, 2013 for cardiorespiratory topics. The aim of this search was to obtain a representation of the cardiovascular topics commonly used by undergraduate medical students. The medical textbooks searched in this study were used in identifying these topics. A list showing these cardiovascular topics and mechanisms was created and used in guiding the search of the eMedicine website. Advanced topics and those required at the postgraduate level were not included. To ensure that all evaluators were criticizing the same content, PDF copies for each article (n ϭ 48) were printed out from the eMedicine (Medscape) website on that day. Evaluation tool. To ensure consistency among evaluators, appraisal forms were constructed for this purpose. The forms used in evaluation were similar to those discussed for medical textbooks. Due to the continuous changes and updating/editing of eMedicine articles, the evaluators were informed to use only the material given to them and not to consult articles on the website. Piloting the evaluation. Before the scoring system was applied to the eMedicine topics, the study was piloted. A total of 10 topics (other than those included in the study) were randomly selected and used for this purpose. The assessors applied the scoring system independently. None of the assessors discussed their findings or the outcomes of their work. An Excel sheet was then produced, summarizing the three assessor’s work, and the findings were discussed in a meeting. In this discussion, reasons for inconsistencies were identified and discussed. This process helped in improving the form as well as training the assessors on how to critically evaluate each article. The three asses- sors independently applied the scoring system for another 10 articles. The number of medical diagrams used in these topics to explain mechanisms were also identified and counted. Thus, contents of mechanisms were examined for content congruent with current needs in integrated undergraduate medical curricula.
from eMedicine (Medscape) independently. Topics that were difficult to evaluate and/or when there were disagreements among assessors were discussed in a meeting. Consistency among the three assessors was measured using Cohen’s interrater correlation (21, 43). YouTube Videos on Cardiovascular Mechanisms Selection of videos. From October 1 to October 15, 2013, the YouTube website (www.youtube.com) was searched using the fol- lowing key words: “cardiovascular mechanisms,” “cardiovascular pathogenesis,” “concept map cardiovascular,” “physiology mecha- nisms,” “heart diseases mechanisms,” “heart diseases pathogenesis,” and “concept maps heart diseases.” In the YouTube search, quotation marks were used with these terms to specify that these terms must be present. Only videos in the English language were identified, and the related URL was recorded. The three assessors independently using the search key words conducted the search, and the search results were evaluated and used to compile a common pool that was used in further analysis. The inclusion criteria were videos covering mechanisms or pathogenesis of the cardiovascular diseases in adults. Videos were excluded if they were 1) not in the English language, 2) an advertise- ment or news, 3) discussing signs or symptoms of diseases affecting the cardiovascular system, 4) about patients with cardiovascular diseases reflecting on their experiences or roles, 5) a lecture on a cardiovascular disease, 6) about drugs used in the treatment of cardio- vascular diseases, or 7) about a clinical examination of the cardiovas- cular system. Duplicated videos were excluded, and repeats were treated as a single file for analysis. The repeat file with the greatest number of hits was used for the analysis. For each video, the following data were collected: title, duration of the video, number of days on YouTube, total number of viewers, and name of the uploader/ creator (organization, group of people, one person). Because the number of days on YouTube varied widely among videos, it was Staying Current 125
LEARNING RESOURCES AND MECHANISMS Advances in Physiology Education • doi:10.1152/advan.00149.2013 • http://advan.physiology.org by 10.220.33.2 on February 5, 2017 http://advan.physiology.org/ Downloaded from
decided to calculate viewership per day as a more accurate parameter compared with total number of viewers. The viewership per day is the ratio of number of viewers to the number of days a video is on YouTube. The number of days was calculated from the day of uploading on YouTube up to October 7, 2013. This calculation of viewership per day was conducted for each video. Evaluation tool. The criteria used for the evaluation of videos have been described in detail in an earlier work (4, 6) with some modifi- cation to suit this study. In summary, the design of the criteria was based on four main domains: video content, technical aspects, author- ity/creator, and pedagogy used. The items in the criteria were grouped under two categories: major and minor. Major criteria comprised the following: 1) the video uses vibrant animations or a flow diagram to demonstrate the mechanism, 2) the contents about the mechanism are scientifically correct, 3) the images are clear, 4) the topic is clearly presented and is engaging, and 5) sounds are clear and the background is free from noise. Minor criteria comprised the following: 1) the video covers the topic identified in the title, 2) the video is designed at the level of undergraduate medical students, 3) the time to down- load is reasonable ( ϳ5–10 min at the maximum, not uninterrupted, or there was no challenge to download as reported by the three evalua- tors), 4) the educational objectives are stated, and 5) the creator/or the organization providing the video is mentioned. These criteria were used to categorize videos into educationally useful and noneducation- ally useful videos. “Educationally useful” means that the video pro- vides scientifically correct and up-to-date knowledge and its contents are accepted by educators in other teaching institutes and match with current information in the literature. As per the basis of the evaluation criteria, educationally useful videos should fulfill the four domains: scientific content, technical aspects, authority/creator, and pedagogy used. Two scores were allocated for each item in major criteria, and one score was allocated to each item under minor criteria. If an item was fulfilled, an allocated score was given; if an item was not fulfilled, a zero was given. No half scores were used. As per our previous research work, educationally useful videos should fulfill all major criteria items as the minimum requirements plus at least three items from minor criteria (4, 6). Piloting the evaluation. Before the tool was applied, the criteria were piloted. A total of 20 videos (other than those identified) were randomly selected and used for this purpose. The criteria were applied independently by the three assessors. None of the assessors shared their findings or discussed the outcome of their evaluation. An Excel sheet covering the results from the three evaluations was then dis- cussed in a meeting. Agreement among the assessors was Ͼ95%. The findings were discussed among the researchers. The criteria items were tested again independently by the three assessors using another 20 videos. The videos were then rated independently by the three assessors. If videos were difficult to classify or when there was a disagreement that arose among assessors, evaluators reviewed such videos in a meeting and reached a final agreement. Assessing the videos. The three evaluators independently evaluated the videos covering the cardiovascular mechanisms. Only 29 videos fulfilled the inclusion criteria. The data were entered using Microsoft Excel 2010 (Microsoft, Redmond, WA) and were checked before any analysis was conducted. Agreement between the evaluators was cal- culated using Cohen’s interrater correlation (21, 43).
Analysis was conducted using SPSS software (version 18.0 for Microsoft Windows, SPSS, Chicago, IL), and results were reported as means, SDs, percentages, and minimums and maximums. t-Tests and ANOVA were conducted to determine significant differences (32, 40). To assess the degree to which different raters agreed in their assess- ment decisions, Cohen’s for interrater reliability was used to assess interrater reliability (21, 43).
The search ended with the identification of seven text- books on human physiology, four textbooks on pathology, and six textbooks on internal medicine commonly used in teaching in undergraduate medical courses (Table 1). The 17 textbooks met the search criteria and were obtained for further assessment. The number of chapters on cardiovas- cular diseases/system and blood vessels in the 17 textbooks was 65. The percentage of cardiovascular mechanism con- tent in physiology textbooks ranged from 5.4% [4 of 74, Preston and Wilson (31)] to 28% [14 of 50, Mulroney and Myers (29)], in pathology textbooks from 7.6% [4.5 of 59, Underwood and Cross (38)] to 24.0% [24.5 of 102, Rubin et al. (34)], and in internal medicine from 0.9% [1.5 of 152, McPhee et al. (28)] to 10.1% [29 of 285, Longo et al. (27); Table 1]. The overall average for cardiovascular mecha- nisms was 16.1% (99.5 of 618) in the seven textbooks on physiology, 17.5% (64 of 364) in the four textbooks on pathology, and only 6.9% (79.7 of 1,150) in the six text- books on internal medicine. The percentage of figures com- mitted to explain cardiovascular mechanisms in the physi- ology textbooks ranged from 7.2% [7 of 97, Preston and Wilson (31)] to 30% [9 of 30, Mulroney and Myers (29)]. In the pathology textbooks, the percentage of figures commit- ted to cardiovascular mechanisms ranged from 5.2% [3 of 57, Underwood and Cross (38)] to 24% [12 of 50, Rubin and Reisner (33)]. In the internal medicine textbooks, the per- centage of figures committed to cardiovascular mechanisms ranged from 0.0% [0 of 3, McPhee et al. (28)] to 9.7% [17 of 179, Longo et al. (27)]. All internal medicine textbooks except Longo et al. (27) contained little information about cardiovascular mecha- nisms. For example, the textbook by McPhee et al. (28) focused mainly on clinical findings such as symptoms, clinical signs, investigations, differential diagnosis, treat- ment, and prognosis. Although the etiology of diseases was provided, no pathophysiology or mechanisms were given. Furthermore, no flow diagrams outlining mechanisms or the pathogenesis of diseases were given. The textbook by An- dereoli et al. (3) is a good textbook for undergraduate medical students, but mechanisms were limited to certain diseases. No flow diagrams outlining mechanisms or the pathogenesis of diseases were given. The textbook by Longo et al. (27) scored highest (10.1%) in relation to the percent- age of cardiovascular mechanisms. However, more attention to pathophysiology and mechanisms should be considered in future editions. The three textbooks by Colledge et al. (13), Kumar and Clark (23), and Goldman and Ausiello (18) provided cardiovascular mechanisms at relatively reason- able percentages: 8.3%, 7.1%, and 7.0, respectively. Apart from the textbooks by Mulroney and Myers (29), Sherwood (35), Rubin and Reisner (33), and Widmaier et al. (42), none of the remaining textbooks used flow diagrams to outline mechanisms and explain the pathogenesis/pathophysiology of cardiovascular diseases. These textbooks also limited the mechanisms at physiological or pathological aspects with no links to clinical symptoms, signs, or investigation results. Staying Current 126 LEARNING RESOURCES AND MECHANISMS Advances in Physiology Education • doi:10.1152/advan.00149.2013 • http://advan.physiology.org by 10.220.33.2 on February 5, 2017 http://advan.physiology.org/ Downloaded from
Table 1.
of cardiovascular mechanisms in medical textbooks Authors
Reference Discipline Chapter Pages
on Mechanisms Total Pages
Percentage of Mechanisms Figures and
Tables on Mechanisms Total Figures
and Tables
Percentage of Mechanism Content Clarity
Quality Adequacy
Comments Widmaier
et al.
42 Physiology Cardiovascular physiology 19 81
21 figures
and 0 tables 79 figures
and 15 tables 26.5 and
0 3 2 2 Key
mechanisms are
provided with
several flow
diagrams. However,
mechanisms are
not integrated with pathology and clinical
aspects. Sherwood
35 Physiology Cardiac physiology 23 86 26.7 16 figures
and 2 tables 70 figures
and9 tables
22.8 and
22.2 3 3 2 Excellent resource for
physiological mechanisms. However, mechanisms are not
integrated with
pathological and
clinical aspects.
Barrett et al. 8 Physiology Cardiovascular physiology (2 chapters) 8.5 95 8.9 14 figures
and 0 tables 93 figures
and 27 tables 15.0 and
0 1 1 1 Less
focus has
been given
to mechanisms. Mulroney and
Myers 29 Physiology Cardiovascular physiology (2 chapters) 14 50 28 9 figures
and 0 tables 30 figures
and 0 tables 30 and
0 3 3 2 Excellent resource for
mechanisms, but
there are
no integration with pathological and clinical
aspects. Costanzo
15 Physiology Cardiovascular physiology 10 51
4 figures
and 2 tables 21 figures
and 6 tables 19.0 and
33.3 3 2 2 Despite
the small
size of the book, mechanisms were covered
and flow
diagrams were
used. Preston
and Wilson
31 Physiology Cardiovascular system
(5 chapters) 4 74
7 figures
and 0 tables 97 figures
and 0 tables 7.2 and
0 1 1 1 Mechanisms were not
adequately discussed. Born and
Boulpaep 10 Physiology Cardiovascular system
21 181
11.6 12 figures and 4 tables 120 figures
and 34 tables 10 and
11.7 2 2 2 One
of the
chapters was
committed to mechanisms. Rubin and
Reisner 33 Pathology Blood vessels
and the
heart(2 chapters) 16.5 122
13.5 12 figures and 2 tables 50 figures
and 10 tables 24 and
20 2 2 2 A well-illustrated resource for
learning pathology. However, mechanisms need to
strengthened. Rubin
et al.
34 Pathology Blood vessels
and the
heart (2 chapters) 24.5 102
24.0 20 figures and 4 tables 101 figures
and 17 tables 19.8 and
23.5 2 2 2 A well-illustrated resource on pathology. However, mechanisms need to
strengthened. Underwood and Cross
38 Pathology Cardiovascular system
(2 chapters) 4.5 59
3 figures
and 0 tables 57 figures
and 8 tables 5.2 and
0 1 1 1 The
focus is on clinic- pathological features. Pathogenesis and mechanisms are briefly
discussed. Kumar
et al.
24 Pathology Blood vessels
and the
heart (2 chapters) 18.5 81 22.8 10 figures
and 2 tables 69 figures
and 11 tables 14.4 and
18.1 2 2 2 A well-illustrated and comprehensive textbook. The
pathogenesis of diseases is clearly
provided, but
this varied
from disease
to disease.
Flow diagrams
are needed.
Continued Staying Current 127 LEARNING RESOURCES AND MECHANISMS Advances in Physiology Education • doi:10.1152/advan.00149.2013 • http://advan.physiology.org by 10.220.33.2 on February 5, 2017 http://advan.physiology.org/ Downloaded from
Table 1.—
Continued Authors
Reference Discipline Chapter Pages
on Mechanisms Total Pages
Percentage of Mechanisms Figures and
Tables on Mechanisms Total Figures
and Tables
Percentage of Mechanism Content Clarity
Quality Adequacy
Comments Kumar
and Clark
13 Medicine
Cardiovascular disease
9.25 130
7.1 10 figures and 2 tables 129 figures
and 49 tables 7.7 and
4.0 3 2 2 Mechanisms for arrhythmias, heart failure,
valvular heart
diseases, and
systemic hypertension are briefly
given. McPhee
et al.
28 Medicine
Heart disease,
systemic hypertension, and blood
vessels and
lymphatic disorders (3 chapters) 1.5 152
0.9 0 figures and 0 tables 3 figures
and 27 tables 0 and
0 1 1 1 Although
etiology is provided, no pathophysiology or mechanisms are given.
Colledge et al. 23 Medicine
Cardiovascular disease
10 120
8.3 4 figures and 0 tables 105 figures
and 130
tables 3.8
and 0 2 2 1 A good textbook
for undergraduate students. However,
mechanisms are
limited to a few diseases. Longo et
27 Medicine
Disorders of the cardiovascular system
(27 chapters) 29 285
10.1 17 figures and 3 tables 179 figures
and 86 tables 9.4 and
3.4 3 3 2 An excellent resource for
clinical medicine. However, mechanisms are limited
to certain
diseases. Andreoli
et al.
3 Medicine
Cardiovascular disease
(11 chapters) 9 166
5.4 2 figures and 1 table 79 figures
and 60 tables 2.5 and
1.6 1 1 1 An excellent resource for
clinical medicine. However, mechanisms are limited
to certain
diseases. Goldman
and Ausiello
18 Medicine
Cardiovascular disease
21 297
7.0 9 figures and 2 tables 195 figures
and 124
tables 4.6
and 1.6
2 2 1 Mechanisms were
clearly outlined
for a number of diseases
but were
brief. No flow diagrams used.
Staying Current 128
LEARNING RESOURCES AND MECHANISMS Advances in Physiology Education • doi:10.1152/advan.00149.2013 • http://advan.physiology.org by 10.220.33.2 on February 5, 2017 http://advan.physiology.org/ Downloaded from
eMedicine Topics A total of 48 topics from eMedicine (Medscape) on cardio- vascular diseases were identified and evaluated for mecha- nisms (Table 2). The percentage of cardiovascular mechanism content varied from 0% in several topics, such as alcoholic cardiomyopathy, acute coronary syndrome, and hypertensive heart disease, to 41.6% (2.5 of 6) for the topic on renovascular hypertension. The overall average for the cardiovascular mech- anisms in the 48 topics was 15.8% (46.2 of 292). Cardiovas- cular mechanisms were adequately outlined in 22.9% (11 of 48) topics, for example, atrioventricular dissociation, paroxys- mal supraventricular tachycardia, premature ventricular con- traction, cardiogenic pulmonary oedema, cardiogenic shock, dilated cardiomyopathy, coronary artery atherosclerosis, heart failure, long QT syndrome, pulmonary edema, and infective endocarditis. In the majority of these diseases, no flow dia- grams outlining the mechanisms at the body system, organ, cellular, and molecular levels were provided. Table 2 summa- rizes examples of the limitations/deficiencies observed in some of the mechanisms given. YouTube Videos A total of 1,150 YouTube videos were found on the initial search and on applying the inclusion criteria and visual exam- ination of the videos; only 29 videos were found relevant to cardiovascular mechanisms (Table 3). The total duration of these video clips was 414 min and 14 s. The application of the criteria by the three evaluators independently revealed that there were 16 educationally useful videos, scoring 14.1 Ϯ 0.5 (mean
Ϯ SD), and the remaining 13 videos were not educa- tionally useful, scoring 6.1 Ϯ 1.72. The difference between the two groups was significant (P Ͻ 0.001). The total duration of useful videos was 340 min and 07 s. The total number of viewers of all videos was 274,077. The useful videos attracted 209,597 (76.4%) of all viewers. Table 3 summarizes key information about the 29 videos included in the study. Except for two videos produced by a pharmaceutical com- pany for educational purposes, all other educationally useful videos were created by physicians and professional bodies/ institutions and were linked to organizations such as East Carolina University, Harvard Medical School, and Brigham and Women’s Hospital, Boston, Massachusetts. The videos addressed mechanisms of several cardiovascular diseases, in- cluding mechanisms and the pathogenesis of systolic and diastolic heart failure, coronary artery disease, atherosclerosis, hypertensive nephropathy, cardiac arrhythmias, and pulmonary arterial hypertension. The majority of noneducationally useful videos failed two of the major criteria items (23%, 3 of 13), three items from the major criteria (30.7%, 4 of 13), and four or more items from the major criteria (46.1, 6 of 13). Minor criteria items were also not fulfilled in these videos, ranging from one to three items not fulfilled. In other words, these videos failed to provide clear animations or flow diagrams to demonstrate the mechanism, the topic was not clearly presented and was not engaging, and sounds were not clear and there was noise in the background. These videos also failed to address one or two items from the minor criteria items. Agreement Between Assessors Agreement between the three assessors was calculated using Cohen’s interrater correlation. The score was in the range of 0.55– 0.95 for cardiovascular mechanisms in textbooks and Medscape. The overall score was in the range of 0.78 – 0.96. Yüklə 89,82 Kb. Dostları ilə paylaş:
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