Optimizing Communication Strategies for COPD Management: Effectiveness of Educational Video and Pamphlet Interventions

Optimizing Communication Strategies for COPD Management: Effectiveness of Educational Video and Pamphlet Interventions | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Optimizing Communication Strategies for COPD Management: Effectiveness of Educational Video and Pamphlet Interventions View ORCID Profile Jeenat Mehareen , Sharon Zhu , Jim Johnson , View ORCID Profile Mohsen Sadatsafavi , View ORCID Profile Erica Frank doi: https://doi.org/10.1101/2025.08.28.25334616 Jeenat Mehareen 1 Faculty of Pharmaceutical Sciences, University of British Columbia , Vancouver, BC, Canada MA Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Jeenat Mehareen For correspondence: jeenatm{at}student.ubc.ca Sharon Zhu 2 Faculty of Sciences, University of British Columbia , Vancouver, BC, Canada BSc Find this author on Google Scholar Find this author on PubMed Search for this author on this site Jim Johnson 3 Patient Research Partner , Vancouver, BC, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site Mohsen Sadatsafavi 1 Faculty of Pharmaceutical Sciences, University of British Columbia , Vancouver, BC, Canada MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Mohsen Sadatsafavi Erica Frank 3 Patient Research Partner , Vancouver, BC, Canada 4 Faculty of Medicine, University of British Columbia , Vancouver, BC, Canada MD, MPH, FACPM Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Erica Frank Abstract Full Text Info/History Metrics Supplementary material Data/Code Preview PDF Abstract Objectives Risk prediction models are increasingly used at point of care to support personalized treatment decisions. This study created and evaluated two Information, Education, and Communication (IEC) resources to improve public understanding of a risk prediction tool for Chronic Obstructive Pulmonary Disease (COPD) management. Methods We created a 5-minute video and a pamphlet explaining the burden of COPD and how a prediction model generates quantitative estimates of, and benefit of certain treatments for, exacerbations of the disease. These tools were tested among students and researchers in public health. A patient partner was engaged throughout to ensure the materials were accessible and patient-centered. Results Twenty-five individuals participated (80% female; 60% aged 25–64). After reviewing the materials, 92% of participants agreed to the statement “I am familiar with the idea of precision medicine approach”. Most (72%) felt they received sufficient information about the tool, and 92% believed such materials could support patient decision. Participants stated that the materials were clear, detailed, and written in plain language. Participants preferred the pamphlet (68%) over the video (44%). Suggestions for improvement included expanding content on how the tool works. Conclusions The findings of this study provided a better understanding of how to present complex medical information around precision medicine that is accessible and meaningful to diverse audiences. We will improve our materials based on these comments, and continue to make them available at https://resp.core.ubc.ca/show/patient_committee_2025 Introduction Risk prediction models are increasingly implemented at point of care as major enablers of personalized treatment decisions. 1 , 2 These models can improve medication adherence and health outcomes as patient characteristics are objectively taken into consideration for guiding healthcare decisions. 3 , 4 Effective communication between patients and physicians is important when communicating risks calculated from this model and discussing individualized treatment decisions. However, their complexity often makes it difficult for physicians to explain risk estimates during brief clinical encounters. This communication gap can limit the utility of risk prediction models for shared decision-making. In the management of Chronic Obstructive Pulmonary Disease (COPD), patients are often faced with complex treatment decisions regarding the prevention of the occurrence of exacerbations (also known as “lung attacks”). 5 Tools that predict exacerbation risk can provide a backbone for better understanding the risk and for shared decision-making. One such tool is the Acute COPD Exacerbation Prediction Tool (ACCEPT) 6 —a risk prediction model that estimates an individual’s risk of exacerbations in the next 12 months given selected individual and clinical features (predictors) and provides treatment recommendations aligned with existing pharmacotherapy guidelines. Under the IMplementing Predictive Analytics towards efficient COPD Treatments (IMPACT) study, ACCEPT is currently being implemented and examined in two tertiary medical hospitals. 7 Physicians use the tool’s prediction to provide patients with tailored treatment suggestions. These recommendations are typically delivered as an information sheet, which can be further customized to include individualized advice. Although patient education has been shown to improve quality of life and reduce hospitalizations 8 , the current information sheets focus mainly on presenting patients’ risk status and corresponding medication recommendations. They offer little insight into how predictions are generated or why the tool should be trusted. This lack of information can undermine patient confidence in the model’s outputs and limit engagement with the recommended treatment plan. To address the communication gap around risk prediction tools, we conducted a study to develop and test two Information, Education, and Communication (IEC) resources. These materials explain the concept of precision medicine and its application in managing COPD exacerbations in lay language, using ACCEPT as an example. As the ongoing IMPACT study evaluates the clinical and cost-effectiveness of ACCEPT, positive results may lead to broader implementation of the tool. We therefore explored next steps by evaluating how best to communicate model-based risk predictions to patients and the public using these IEC resources. The primary goal was to evaluate how these materials increase understanding of risk prediction tools in COPD care. Methods The study received institutional ethics approval from University of British Columbia (H23-00445). The design of the IEC materials was guided by existing evidence on effective health communication. 9 Research indicates that combining simple language with visuals improves patient engagement and recall, especially for complex topics like pharmacogenomics and precision medicine. 10 , 11 Short videos have also been found to enhance comprehension of medical concepts. 12 Drawing on this evidence, two materials, a video and a pamphlet—were developed. A patient partner with lived experience of COPD was engaged throughout the project, beginning with feedback on the initial study design and continuing through the co-creation of materials and review of survey questions used for evaluation. His contributions helped refine both content and presentation, ensured that the resources were relevant, accessible, and meaningful for patients managing COPD as well as understandable to a general audience. The video ( Please contact corresponding author to request access ), approximately five minutes in length, explained the purpose of the ACCEPT tool, how it predicts the risk of future exacerbations, and how this information supports shared decision-making. To ensure accessibility, the video used plain language and deliberate pacing. The script combined two perspectives: a physician (co-author EF) who explained what COPD is, the concept of precision medicine, and how ACCEPT works, and the patient partner (co-author JJ), who shared his experience living with COPD and discussed how tools like ACCEPT could benefit patients. A complementary pamphlet ( Supplementary Figure A1 ) presented the same key information in a brief, easy-to-read format. The content was adapted from publicly available resources, written at an approximately Grade 8 reading level, and organized with clear sections and visuals to improve readability. The patient partner reviewed and provided feedback on the content, layout drafts, and design features to highlight the most relevant information and improve readability. Finally, graduate students and researchers in Public Health at the University of British Columbia reviewed both IEC resources and completed the survey, which captured demographics and assessed comprehension, satisfaction, and format preference. Descriptive statistics were used to summarize participant demographics and feedback on IEC materials. For paired comparisons of ordinal responses (e.g., Likert-scale ratings) between the video and pamphlet formats, the Wilcoxon signed-rank test was used to assess differences in participant perceptions (e.g., clarity, visual engagement, and overall preference). A p-value of <0.05 was considered statistically significant. All analyses were conducted using Microsoft Excel and Rstudio. Results Twenty-five individuals participated in the study (80% female, 60% aged 25-64). 56% were public health students ( Table 1 ). Table 2 provides the participants’ level of agreement regarding the IEC materials. After evaluating both the video and pamphlet, 92% of participants agreed or strongly agreed that they became familiar with the benefits of precision medicine towards COPD management. 72% reported receiving sufficient information about the prediction tool (ACCEPT), while 92% believed similar materials could facilitate conversations about precision medicine applications for disease management among patients. Regarding the clarity and accessibility of the materials, 92% agreed or strongly agreed that the content was easy to understand, and 96% felt that the language used was appropriate and accessible. View this table: View inline View popup Download powerpoint Table 1: Participant demographics View this table: View inline View popup Download powerpoint Table 2: Participants’ feedback on IEC materials Participant feedback on specific format of IEC materials varied ( Table 3 ). For length, most participants felt the length of both the pamphlet and video was appropriate, though 8% more participants rated the video as “too long” compared to the pamphlet. In terms of visual engagement, 72% agreed or strongly agreed that the pamphlet visuals were engaging, compared to 44% for the video (p = 0.040). For clarity, a majority of participants found the visuals to be simple and easy to understand (Pamphlet: 88%, Video: 80%). Similarly, 72% found the style and presentation of the pamphlet to be well executed, compared to 60% for the video (p = 0.080). When asked about their overall preference, 68% of participants agreed or strongly agreed that they preferred the pamphlet, while 40% expressed a preference for the video (p = 0.363). View this table: View inline View popup Download powerpoint Table 3: Participant Ratings and Preferences for Pamphlet vs. Video IEC Materials Responses to open-ended questions suggested that the materials were complementary and useful when used together. However, participants recommended improving the video content to better illustrate how ACCEPT (prediction tool) functions in clinical scenarios. Discussion The findings of this study offer insights into how complex medical information—particularly prediction tools—can be presented in ways that are accessible and meaningful to diverse audiences. Overall, participants found both the video and pamphlet clear, relevant, and easy to understand. Most found the materials accessible and clear, with 72% indicating they received sufficient information to understand how the tool works and how it could inform treatment decisions. This re-establishes the fact that co-developing materials with patient partners safeguards relevance and clarity, which allows for more patient-centered communication. Furthermore, while both formats were well received, participants preferred the pamphlet due to its concise language and visual clarity. Nevertheless, feedback highlighted the complementary strengths of both formats: the pamphlet supported quick reference, while the video offered narrative context and a patient voice—an approach known to improve emotional engagement and retention. 13 Quantitative risk prediction tools based on individual genetic, environmental, and lifestyle factors are major enablers of precision medicine. 14 Despite their promise, their adoption remains limited due to low awareness among patients, providers, and the general public. 15 – 17 A content analysis of U.S. print media found that coverage of precision medicine was largely limited to cancer, with minimal attention to its broader applications. 18 This reinforces the need for improved public education and communication, specially in the field of chronic respiratory diseases such as COPD which is a leading cause of mortality and morbidity worldwide. 19 One major challenge in communicating prediction tools is low health literacy and numeracy, both essential for interpreting probabilistic risk. 20 Public-facing materials such as ACCEPT also require a basic understanding of disease management. Information overload and technical jargon can overwhelm patients, impair decision-making, and erode trust in healthcare systems. 21 , 22 Understanding this importance, our intervention research design focused on accessible, plain-language IEC resources. This study has limitations, including a small sample size and participation limited to individuals in the health sciences, which is not reflective of the broader patient population or general public. Nonetheless, it offers early insights into how precision medicine concepts—particularly risk prediction tools—can be communicated in clearer, more accessible ways. The findings will help guide the future development of patient and public centered IEC resources that support the tool’s effective scale-up and integration into routine COPD care and beyond. Data Availability All data produced in the present study are available upon reasonable request to the authors Contributors JM and SZ are the guarantor of the content of the manuscript, including the data and analysis. Conceptualization (JM and SZ), literature review (JM and SZ), methodology (JM), formal analysis (JM), first drafting of the manuscript (JM and SZ), validation (all authors), review, editing and interpretations (all authors). All authors agreed to be accountable for all aspects of the work. Prior Presentations The article was presented at the ISPOR 2025, May 13-May 16 at Montreal, Canada. Acknowledgement We gratefully acknowledge the Centre for Lung Health for their support in facilitating our collaboration with the patient-partner through their Community Stakeholder Committee. Footnotes ↵ * 1 and 2 are both first authors References 1. ↵ Moriarty AS , Castleton J , McMillan D , et al. The Value of Clinical Prediction Models in General Practice: A Qualitative Study Exploring the Perspectives of People With Lived Experience of Depression and General Practitioners . Health Expect Int J Public Particip Health Care Health Policy . 2024 ; 27 ( 6 ): e70059 . doi: 10.1111/hex.70059 OpenUrl CrossRef 2. ↵ Steyerberg EW , Moons KGM , Van Der Windt DA , et al. Prognosis Research Strategy (PROGRESS) 3: Prognostic Model Research . PLoS Med . 2013 ; 10 ( 2 ): e1001381 . doi: 10.1371/journal.pmed.1001381 OpenUrl CrossRef PubMed 3. ↵ Ginsburg GS , Phillips KA . Precision Medicine: From Science To Value . Health Aff (Millwood) . 2018 ; 37 ( 5 ): 694 – 701 . doi: 10.1377/hlthaff.2017.1624 OpenUrl CrossRef PubMed 4. ↵ Zullig LL , Blalock D , Dougherty S , et al. The new landscape of medication adherence improvement: where population health science meets precision medicine . Patient Prefer Adherence . 2018 ;Volume 12 : 1225 – 1230 . doi: 10.2147/ppa.s165404 OpenUrl CrossRef PubMed 5. ↵ Holverda S , Rutgers MR , Kerstjens HAM . Time to rename COPD exacerbations: implementing the term lung attack . Lancet Respir Med . 2020 ; 8 ( 4 ): e25 . doi: 10.1016/S2213-2600(20)30123-5 OpenUrl CrossRef 6. ↵ Adibi A , Sin DD , Safari A , et al. The Acute COPD Exacerbation Prediction Tool (ACCEPT): a modelling study . Lancet Respir Med . 2020 ; 8 ( 10 ): 1013 – 1021 . doi: 10.1016/S2213-2600(19)30397-2 OpenUrl CrossRef PubMed 7. ↵ Michaux KD , Metcalfe RK , Burns P , et al. IMplementing Predictive Analytics towards efficient COPD Treatments (IMPACT): protocol for a stepped-wedge cluster randomized impact study . Diagn Progn Res . 2023 ; 7 ( 1 ): 3 . doi: 10.1186/s41512-023-00140-6 OpenUrl CrossRef PubMed 8. ↵ Tan JY , Chen JX , Liu XL , et al. A Meta-Analysis on the Impact of Disease-Specific Education Programs on Health Outcomes for Patients with Chronic Obstructive Pulmonary Disease . Geriatr Nur (Lond) . 2012 ; 33 ( 4 ): 280 – 296 . doi: 10.1016/j.gerinurse.2012.03.001 OpenUrl CrossRef 9. ↵ Wynn RM , Adams KT , Kowalski RL , Shivega WG , Ratwani RM , Miller KE . The Patient in Precision Medicine: A Systematic Review Examining Evaluations of Patient-Facing Materials . J Healthc Eng . 2018 ; 2018 : 1 – 10 . doi: 10.1155/2018/9541621 OpenUrl CrossRef 10. ↵ Martínez Silvagnoli L , Shepherd C , Pritchett J , Gardner J. Optimizing Readability and Format of Plain Language Summaries for Medical Research Articles: Cross-sectional Survey Study . J Med Internet Res . 2022 ; 24 ( 1 ): e22122 . doi: 10.2196/22122 OpenUrl CrossRef PubMed 11. ↵ O’Donnell P , Wadhwa N , Danahey K , et al. Pharmacogenomics□Based Point□of□Care Clinical Decision Support Significantly Alters Drug Prescribing . Clin Pharmacol Ther . 2017 ; 102 ( 5 ): 859 – 869 . doi: 10.1002/cpt.709 OpenUrl CrossRef PubMed 12. ↵ Cheng X , Liu J , Dale C. Understanding the Characteristics of Internet Short Video Sharing: A YouTube-Based Measurement Study . IEEE Trans Multimed . 2013 ; 15 ( 5 ): 1184 – 1194 . doi: 10.1109/TMM.2013.2265531 OpenUrl CrossRef 13. ↵ Chatterjee A , Strong G , Meinert E , Milne-Ives M , Halkes M , Wyatt-Haines E. The use of video for patient information and education: A scoping review of the variability and effectiveness of interventions . Patient Educ Couns . 2021 ; 104 ( 9 ): 2189 – 2199 . doi: 10.1016/j.pec.2021.02.009 OpenUrl CrossRef PubMed 14. ↵ Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease . National Academies Press ; 2011 : 13284 . doi: 10.17226/13284 OpenUrl CrossRef 15. ↵ Ginsburg GS , Phillips KA . Precision Medicine: From Science To Value . Health Aff (Millwood) . 2018 ; 37 ( 5 ): 694 – 701 . doi: 10.1377/hlthaff.2017.1624 OpenUrl CrossRef PubMed 16. Mitchell S , Jaccard E , Schmitz FM , et al. Investigating acceptability of a training programme in precision medicine for frontline healthcare professionals: a mixed methods study . BMC Med Educ . 2022 ; 22 ( 1 ): 556 . doi: 10.1186/s12909-022-03613-2 OpenUrl CrossRef PubMed 17. ↵ Lamichhane P , Agrawal A. Precision medicine and implications in medical education . Ann Med Surg . 2023 ; 85 ( 4 ): 1342 – 1345 . doi: 10.1097/MS9.0000000000000298 OpenUrl CrossRef 18. ↵ Peng W , Seo HY , Choi J , Jia X. Imbalanced media portrayal: a content analysis of precision medicine in US news of 2015–2021 . Front Commun . 2024 ; 9 : 1366952 . doi: 10.3389/fcomm.2024.1366952 OpenUrl CrossRef 19. ↵ Chen S , Kuhn M , Prettner K , et al. The global economic burden of chronic obstructive pulmonary disease for 204 countries and territories in 2020–50: a health-augmented macroeconomic modelling study . Lancet Glob Health . 2023 ; 11 ( 8 ): e1183 – e1193 . doi: 10.1016/S2214-109X(23)00217-6 OpenUrl CrossRef 20. ↵ Berkman ND , Sheridan SL , Donahue KE , Halpern DJ , Crotty K. Low Health Literacy and Health Outcomes: An Updated Systematic Review . Ann Intern Med . 2011 ; 155 ( 2 ): 97 . doi: 10.7326/0003-4819-155-2-201107190-00005 OpenUrl CrossRef PubMed Web of Science 21. ↵ Klerings I , Weinhandl AS , Thaler KJ . Information overload in healthcare: too much of a good thing? Z Für Evidenz Fortbild Qual Im Gesundheitswesen . 2015 ; 109 ( 4-5 ): 285 – 290 . doi: 10.1016/j.zefq.2015.06.005 OpenUrl CrossRef PubMed 22. ↵ Chandra S , Mohammadnezhad M , Ward P. Trust and Communication in a Doctor-Patient Relationship: A Literature Review . J Healthc Commun . 2018 ; 03 ( 03 ). doi: 10.4172/2472-1654.100146 OpenUrl CrossRef View the discussion thread. Back to top Previous Next Posted September 02, 2025. Download PDF Supplementary Material Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following Optimizing Communication Strategies for COPD Management: Effectiveness of Educational Video and Pamphlet Interventions Message Subject (Your Name) has forwarded a page to you from medRxiv Message Body (Your Name) thought you would like to see this page from the medRxiv website. Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Share Optimizing Communication Strategies for COPD Management: Effectiveness of Educational Video and Pamphlet Interventions Jeenat Mehareen , Sharon Zhu , Jim Johnson , Mohsen Sadatsafavi , Erica Frank medRxiv 2025.08.28.25334616; doi: https://doi.org/10.1101/2025.08.28.25334616 Share This Article: Copy Citation Tools Optimizing Communication Strategies for COPD Management: Effectiveness of Educational Video and Pamphlet Interventions Jeenat Mehareen , Sharon Zhu , Jim Johnson , Mohsen Sadatsafavi , Erica Frank medRxiv 2025.08.28.25334616; doi: https://doi.org/10.1101/2025.08.28.25334616 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Medical Education Subject Areas All Articles Addiction Medicine (567) Allergy and Immunology (863) Anesthesia (297) Cardiovascular Medicine (4411) Dentistry and Oral Medicine (443) Dermatology (380) Emergency Medicine (606) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1505) Epidemiology (15205) Forensic Medicine (30) Gastroenterology (1119) Genetic and Genomic Medicine (6574) Geriatric Medicine (666) Health Economics (994) Health Informatics (4511) Health Policy (1365) Health Systems and Quality Improvement (1608) Hematology (537) HIV/AIDS (1263) Infectious Diseases (except HIV/AIDS) (15903) Intensive Care and Critical Care Medicine (1103) Medical Education (620) Medical Ethics (144) Nephrology (666) Neurology (6573) Nursing (345) Nutrition (998) Obstetrics and Gynecology (1139) Occupational and Environmental Health (954) Oncology (3319) Ophthalmology (968) Orthopedics (369) Otolaryngology (420) Pain Medicine (435) Palliative Medicine (129) Pathology (662) Pediatrics (1689) Pharmacology and Therapeutics (691) Primary Care Research (710) Psychiatry and Clinical Psychology (5422) Public and Global Health (9205) Radiology and Imaging (2191) Rehabilitation Medicine and Physical Therapy (1367) Respiratory Medicine (1191) Rheumatology (593) Sexual and Reproductive Health (709) Sports Medicine (529) Surgery (709) Toxicology (99) Transplantation (288) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'9feba0f26d38f047',t:'MTc3OTI4MzEyMQ=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();