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Table 2 Summary of included articles

From: Uses of quick response codes in healthcare education: a scoping review

Avidan et al., 2015 [19]Anaesthetic traineesTo evaluate the use of QR codes for resident case log managementQR codes containing anaesthesia syllabus data were introduced into an anaesthesia information management system. Codes were automatically generated at the conclusion of each case for resident case logging using a smart deviceQR codes were used for case logging after 3 months by 17/26 trainees (65.4%) after 3 months and by 15/25 residents (60%) after 6 months. Usability was rated as good by 9/17 trainees (52.9%) or very good by 7/17 trainees (41.2%) after 3 months. Usability was rated as good by 8/15 trainees (53.3%) or very good by 7/15 trainees (46.7%) after 6 months. Most residents would recommend the use of QR codes for case logging to colleagues who were not using them (At 3 months: 15/17 (88.2%) and at 6 months: 14/15 93.3%). The overall rate of case logging increased from 46.2 to 92.3% after the introduction of QR codesNone identified
Bellot et al., 2015 [20]Doctor of nursing practice studentsTo evaluate students’ experiences of using QR codes during a course practicumCreation of a doctoral-level practicum experience using QR coding to create interactive, individualised patient or provider resource guidesAll students reported that creating and scanning QR codes was easy. 83% agreed that QR codes would be of benefit to health care providers and patients in the clinical and community settings. All students stated they were likely to use QR technology in the futureQR codes need to be linked to mobile websites rather than HTML sites to ensure compatibility with mobile devices. Access to the technology necessary to enable full use of a QR-enhanced resource guide
Bukowski et al., 2016 [21]NursesTo discuss the structure, current results and future work of an interactive serious gameGamification of a medication sorting task, in which QR codes were used to identify the simulated patient and their medication requirementsNone identifiedDifficulty in identification of the QR code in three gaming rounds
Carlson & Gagnon, 2016 [22]Healthcare studentsTo test four prototypes of an augmented reality integrated simulationAn augmented reality and interactive storytelling application was used for simulation. This used QR codes placed around the room to trigger prompts, such as videos, locations, diagrams or scriptsStatements regarding the prototypes were rated positively.Concerns regarding unclear navigation and lack of prompts in some scenarios. Respondents felt the project was not a replacement of simulation
Chang et al., 2018 [23]Healthcare staffTo describe the development, implementation and initial evaluation of a QR code system integrated within an online leaderboard for cardiopulmonary resuscitation performanceQR codes were used to facilitate a simulation-based cardiopulmonary resuscitation performance leaderboard. After a simulated CPR practice, the participant scanned his or her QR code in order to upload their performance scoreThe competitive nature of the leaderboard was viewed as divisiveTechnical difficulties with the QR code system acted as a barrier to the leaderboard’s longevity. Self-identified “tech averse” were intimidated by the system due to its dependence on coordinating a reliable Wi-Fi and QR code reader application software. Lack of automatic data upload with the QR code system being used as a workaround
Damjanovic et al., 2017 [24]Medical studentsAdaptation of ultrasound simulation software for use in point-of-care ultrasound education to make it affordable and applicable in any simulation settingQR codes were integrated into training phantoms as part of the simulation training scenarios in order to start displaying video clipsWhen using QR codes, no additional hardware is required for this simulation in comparison to the use of RFID or NFC tags. Therefore, it can remotely be made available for downloadThis simulation does not encourage probe manipulation and image optimisation skills in comparison to commercially available systems. Review and quality control of linked teaching materials has to be undertaken along with correct coding for corresponding video clips, which can be time consuming
Downer et al., 2016 [25]Nursing and midwifery studentsTo report on a pilot study in which QR codes were used in the clinical laboratory to enhance learningQR codes were placed on equipment that students were learning how to use and linked to a best-practice videos to remind them how to use the equipmentStudents have an “expert” to guide them even when faculty are not available. Students are able to practice skills at a time and place that is convenient for them. When asked their preferred method of access to videos, students commented that QR codes “would probably provide best … and quickest access” as they were “faster and less confusing” and they were the “easiest to access”None identified
Gardiner et al., 2017 [26]Plastic surgery traineesNot applicableQR codes were used by trainee plastic surgeons to check the latest departmental guidelines. Also, trialing the use of QR codes to deliver patient information leafletsQR codes have a significant role to play in disseminating information to both patients and colleagues. They are free to create, allow frequent updates, never ‘run out’ and save on the cost and environmental consequences of printing updated leaflets.”None identified
Jamu et al., 2016 [27]Nursing staffTo evaluate the effectiveness, acceptability and feasibility of QR codes for multi-professional Just in Time learningQR Codes were generated for clinical guidelines and policies and positioned at relevant locations on a medical ward for access by nurses as part of the Just in Time learning paradigmParticipants could access pertinent information anytime, anywhere and at the point of need.Several practitioners in the project had little or no experience with educational technology and did not know their phones were smartphones. There were barriers with accessibility of smartphones and placement of QR codes. Reluctance to use devices in clinical areas or in front of patients.
Lin & Teng, 2018 [28]Nursing studentsTo use QR codes to increase engagement in a case-based learning courseQR codes were incorporated into a case-based course to increase student participation and facilitate group discussions during the classes77% of students gave positive ratings for using QR codes in the case-based learning course. On average, participants agreed most with thestatements “I feel it is easy to use QR codes” and “It’s easier for me to ask questions via QR codes”. Participants at different achievement levels showed different attitudes toward the use of QR Codes.Difficulty with scanning the QR codes or with slow download speeds
Lin et al., 2017 [29]Nursing studentsTo explore student’s viewpoints towards the use of quick response codes in a pharmacology course in TaiwanQR codes were integrated into a pharmacology literacy course for students to scan during the 7-week course. This was incorporated through problem-based learning activities and in their textbooksData were collected using the Nursing Students’ Perceptions of Using QR Codes Scale (NSPQS). Most students agreed that QR codes helped them to learn, considered them motivating and increased their interest in learning. Most of the students considered the use of QR codes to be easy and would not increase their burden of learning. QR codes were stated to be convenient and eco-friendly. Participants liked the idea of using QR codes in the class and would like to use QR codes again.Challenges included the requirement to internet access or the use of a mobile carrier. Opposition was also encountered due to students stating that looking at a small smart phone screen for long periods would cause eyestrain. Some students did not have a smart phone and were therefore paired with students that had a smart phone. Some students were more accustomed to conventional ways of learning and believed that surfing the internet distracted them from their work.
MacRae, 2011 [30]Neurosurgery journal readersTo link print content and digital content through the use of smartphonesQR codes are placed on articles in order to connect the reader via smartphone to related videos, figures or tablesNone identifiedNone identified
Mathis et al., 2016 [31]Medical studentsTo increase medical student interest in anaesthesiology through creation of a short guide for their clinical rotationThe short guide for a clinical rotation in anaesthesiology included guidance on skills accompanied by QR-code based video illustrations that could be accessed on a smartphone or personal computer.None identifiedNone identified
Mogali et al., 2019 [32]Medical studentsTo obtain student opinions on the use of QR codes as a learning tool in a medical museum for self- and mobile learning of anatomy and pathologyUsed QR codes to enhance medical students experience when visiting an anatomy specimen museum. This was well received by the students and enhanced their exploration experience. Allowed instantaneous access to further information plus ability to save the document to review later.The majority of students either agreed or strongly agreed that it was easy to access the information about the specimen with QR codes (4.47 ± 0.84), while 96% of students agreed that they were able to correlate the specimen with the annotated images (4.56 ± 0.56). The majority of students (78%) agreed that QR codes were useful for their learning (4.22 ± 0.87), while 75% of students felt QR codes motivated them to visit the Anatomy Resource Centre. Most of the students agreed that QR codes are useful for revision of materials (4.13 ± 1.07) and independent learning (4.38 ± 0.87). These findings suggest that QR codes are not only effective for students learning but also enhance their exploration experience with the museum specimensQR code-tagged specimens contained sensitive images of human organs and tissues. Therefore, students were reminded that the material was meant for personal use only and not to disseminate the content in any form. The PDF documents linked to QR codes were password protected
Reynolds et al., 2014 [33]Obstetric-gynaecology trainees / FacultyTo judge the feasibility and acceptability of a novel electronic system for the evaluation of surgical skillsUnique QR codes were added to residents’ ID badges for scanning by faculty in order to provide feedback after surgical procedures.The evaluation system was quickly accepted by residents and faculty. Thirty (79%) of the 38 indicated it was superior to the previously used handwritten format. 83% stated it provided improved educational benefit and 86^ saw value in continuing this form of resident evaluation. 86% of respondents were satisfied or very satisfied with this format. The electronic system demonstrated improved utilization compared with paper evaluations, with a mean of 23 electronic evaluations submitted per resident during a 6-month period versus 14 paper assessments per resident during an earlier period of 6 months.Some faculty expressed discomfort with using the electronic format because it was unfamiliar technology
Rosario-Raymundo, 2017 [34]Nursing staffTo assess the usability, accessibility and feasibility of using QR codes for mobile learning and the factors that impact thisQR codes were generated that linked to a mobile website, connected to a doctor’s telephone number or revealed alphanumeric information to allow for immediate access at the point of careQR codes demonstrated a high level of functionality, usability and usefulness. The majority of the participants liked the experience of using the QR codes, citing ease of use of the QR codes; a high level of satisfaction in the kind and amount of supplementary medical information accessed; and the favorable effect the QR codes had on their personal learning.Difficulty in scanning codes from a participant which was attributed to a smart phone with an older operating system and limited data storage. Internet connection speed and good lighting were identified as factors that determined ease of use. One participant disliked the need to download a QR code reader
Shustack, 2018 [35]Nursing studentsDiscussed the different uses of QR codes for engaging millennial nursing studentsApplications mentioned include their use in the classroom, simulation laboratory and for creating interactive poster displaysNone identifiedNone identified
Siderits et al., 2011 [36]Tumour board presentation attendeesDescribes the use of QR codes in tumour board presentations to distribute educational contentQR codes were included into every presentation to link to the Tumour Board Toolbox and also provided content for histology images or casesStated to be an easy and effective way to incorporate more educational content from various sources while allowing audience members to conveniently access, acquire, manipulate and share the information. Provides convenience and thoroughness for the educatorAdding a logo into the QR code can cause “disruption” when attempting to scan
Snyder et al., 2018 [37]Medical studentsTo determine whether QR code-linked online feedback forms improve the frequency and efficiency of rater feedbackClerkship students were provided with laminated cards with a QR code on that was scanned by their preceptor after each learning session to provide feedback. This was a multisite evaluation of the innovation.The QR feedback method had the highest usability rating when compared to online or paper methods. Accessing feedback via QR code was associated with the shortest time to prepare feedback. QR feedback forms were found to be portable and easily accessible.Adoption was challenged by limitations in the wireless network at some clerkship sites
Sobhani et al., 2017 [38]Medical studentsTo determine if a QR evaluation tool would improve timeliness, usability and the efficacy of giving and receiving of feedback compared to paper evaluationsSmartphone-based evaluations were created that were accessed from a personal QR code given to each student in the intervention group. These were scanned by instructors to provide feedbackCompared to those using paper evaluations, instructors using QR evaluations were significantly more likely to agree that the evaluation tool was easy to understand (100% vs 43%) and easy to navigate (82% vs 57%), and that the evaluation tool was effective in providing feedback (75% versus 29%). Evaluators using QR codes also felt more comfortable approaching students with the evaluation tool (92% vs 43%)None identified
Tracey et al., 2013 [39]Nursing studentsTo evaluate the use of QR codes for facilitating self-directed learning in a nursing skills laboratoryQR codes were placed at strategic locations in a skills lab to allow students to watch video clips in order to help them learn a skillTo evaluate the activity, students were asked whether they found the use of QR codes to be helpful. “As expected, the response was overwhelmingly positive”. Students stated that using QR codes was “very helpful,” “wished there were more,” and were an “excellent source for learning hands-on topics.”A few of the students did not have a smartphone or did not know how to use one
Traser et al., 2015 [40]Medical students / Doctor of physical therapy studentsTo study student perceptions on the usefulness of QR codes as learning aids in a medical gross anatomy courseQuestion prompts and QR codes were tagged on cadaveric specimens to aid with learningStudents responded positively to the inclusion of QR codes in the gross anatomy laboratory. 56% stated they found the QR codes to be more helpful than traditional study-aids and the majority (89%) felt that QR codes helped them improve their learning of anatomy. A significant positive correlation existed between students’ usage of QR codes and their perception for enhancing learning of anatomy. 81% of students thought codes were accessible during self-directed study timeStudent reluctance to use phones in the gross anatomy laboratory. Lack of adequate technology and complications with scanning QR codes or accessing the internet
Upton et al., 2017 [41]Healthcare staffTo add a QR code to a patient-held immunotherapy alert cardProviding management algorithms via QR codes on patient-held immunotherapy alert cards for healthcare staff looking after patients with potential reactions to novel anti-cancer systemic drugsRationalised benefits include: Availability across all operating systems, quick access to information, cost-effective, small size, ability to save information accessed, monitoring of usage for auditThe use of a static QR code can cause problems if the web page is moved. Lack of familiarity with QR codes amongst staff. Staff not owning a smart phone
Zurmehly & Adams, 2017 [42]Nursing studentsTo explore the use of QR codes in a lecture and measure subsequent student satisfaction and engagementQR codes were included in a medical surgical lecture to reveal the answers for an exercise on ECG rhythm interpretationAll students reported that scanning QR codes was easy, 90% stated that they found the QR codes to be more helpful than traditional textbook pictures, and most (97%) felt that the QR codes helped improve their learning of cardiac rhythm strips. All of the students reported that they would most likely use QR codes in the future. In the course evaluation, students expressed gratitude to the faculty for the use of QR codes and for the creative use of technology for learning in the classroomSome students did not have a smartphone or a phone that could download a QR code reader and were hesitant to indicate this