Bridging theory and practice : learning design for AR-based continuing professional development in a primary care setting

Background: General practitioners (GPs) are the gatekeepers of health care in most societies, serving as patients’ first point of contact. Continuing professional development (CPD) is needed for GPs to improve their competence and provide successful patient care. Information communication technologies (ICTs) are expected to be used to support effective CPD. Augmented reality (AR), as a new ICT, might have a potential as a learning tool for CPD, but it has not been explored in primary care for GPs’ CPD.

Objective: The aim of this study was to determine how to design AR-based CPD to fit the learning needs of primary care physicians in their clinical practice.

Methods: Multiple methods used in design-based research (DBR) were applied in this study. Semi-structured interviews were conducted to understand physicians’ CPD needs and attitudes toward AR (Study I). An integrative review was conducted to understand AR in health care education (Study II). A conceptual framework analysis method (CFAM) was used to construct the AR design framework (Study III). Based on the framework, semi-structured interviews were used to identify AR design needs with the physicians in the chosen setting (Study IV).

Results: Most primary care providers accepted the idea of AR-based CPD, but their current CPD model did not help them become qualified GPs. Although the learning needs varied between physicians, they shared a need for integrated clinical competence. Our integrative review showed that AR has been investigated for various research purposes and for all levels of health professionals; however, except for a few reports supported by situation learning theory, 80 percent of the published papers lacked support from learning theories. Driven by situated, experiential, and transformative learning theories, the Mobile AR Education (MARE) framework was proposed, which included identifying learners’ personal paradigms, clarifying learning objectives (LOs), and designing AR learning environments and learning activities to develop learners’ personal paradigms with respect to domain expectations. The application of MARE has demonstrated physicians’ perspectives of AR design needs with the example of rationally using antibiotics. The guidelines, local antibiotics resistance pattern, and physicians’ personal paradigms related to diagnosis, treatment, and prescription, including the choice of drug, were the context for the design needs.

Conclusions: To my knowledge, this is the first exploration of learning design for AR-based CPD through practice and theory. The main contribution of this thesis is the design of the MARE framework due to a lack of learning theories supporting the use of AR in medical education. The MARE framework as applied to the Chinese primary care setting shows the usefulness of identifying physicians’ personal paradigms in their decision-making process and their expectations for AR-based CPD to improve their personal paradigms. As a future step, AR prototypes and applications might be designed to meet these expectations.

List of scientific papers

I. Zhu E, Fors U, Smedberg Å. Exploring the Needs and Possibilities of Physicians’ Continuing Professional Development - A Qualitative Study in a Chinese Primary Care Context. PLoS ONE. 2018;13(8): e0202635.
https://doi.org/10.1371/journal.pone.0202635

II. Zhu E, Hadadgar A, Masiello I, Zary N. Augmented Reality in Health Care Education: An Integrative Review. PeerJ. 2014;2:e469.
https://doi.org/10.7717/peerj.469

III. Zhu E, Lilienthal A, Shluzas L. A, Masiello I, Zary N. Design of Mobile Augmented Reality in Health Care Education: A Theory-Driven Framework. JMIR Medical Education. 2015; 1(2), e10.
https://doi.org/10.2196/mededu.4443

IV. Zhu E, Fors U, Smedberg Å. Understanding How to Improve Physicians’ Paradigms for Prescribing Antibiotics by Using a Conceptual Design Framework: A Qualitative Study. [Submitted]