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Medical Editorial
Overview
To ensure quality content, our editorial staff focuses on three main strategies:
- Ensure all X-Plain content is evidence-based.
- Use proven instructional strategies based on theories of learning.
- Address patients’ needs at their specific "point of care."
Evidence-based Content
To ensure our content is evidence-based we adhere to the following principles.
- Develop all content in conjunction with medical experts practicing in leading medical institutions in the USA.
- Provide a list of approved sources of medical information to contributors and medical editors. The list includes selected NIH institutes, academic centers and peer-reviewed medical publications.
- Submit X-Plain for review by at least 3 client specialists at leading medical institutions.
- Review each X-Plain topic annually to ensure it corresponds with specialty practice guidelines.
- Request continuous online feedback from medical experts who use X-Plain with their patients.
Focus on Patients’ Needs
Patient needs regarding health information vary depending on their medical condition and the stage of care. The goals of patient education vary from helping patients make a healthcare decision, to teaching self-care skills, promoting healthy lifestyle changes, and providing comfort. To address patients’ needs, X-Plain involves patients in the development of our tutorials. This is done mainly through direct online feedback from real patients using the modules in clinical settings.
Medical Editorial
As we develop the textual content of X-Plain topics, our medical contributors and editors are guided by the following 3 editorial guidelines:
- Standard of care
Write content that reflects national standards of care and adheres to the medico-legal considerations of the related discipline.
- Unbiased content
Keep the presentation objective in order to facilitate fair decision-making. Solicit feedback from target patient populations and include interactive questions that monitor and correct potential misperceptions.
- Patient Advocacy
Write with the patient and consumer in mind, focus on helping patients/consumers make informed health decisions, and understand their self-care instructions and pre-visit/procedure preparations.
Instructional Design
Our content goes through several stages of instructional design, with all drafts checked by contributing medical experts. Our instructional design guidelines are:
- Organize content based on adult learning theories, presenting background information, when needed, to help patients understand more complex health concepts.
- Employ illustrations and animations that simplify and reinforce concepts using theories of message design.
- Ask interactive questions and give feedback to ensure understanding, correct potential misconceptions, and maintain attention through active learning.
- Engage the patient and keep him/her motivated and engaged through relevant content, interactive questions and multimedia.
- Embrace patients at all levels of learning and adhere to “Section 508” accessibility guidelines by employing full narration of the text and touchscreen interfaces.
Accessible/Accessibility
X-Plain was conceived with accessibility in mind. Language is simplified for patients who are functionally-illiterate, text is fully narrated and rendered open-captioned for patients with visual impairments, large font size (24 pt) are used for the elderly population; touch-screen technology and screen design have been adopted for patients with no computer experience.
Patients with cognitive challenges such as attention deficit disorder or with difficulties understanding abstract concepts, can benefit from X-Plain as it reinforces the medical concepts through a variety of learning channels by using text, illustrations, animations, and narration.
Accreditation
The Patient Education Institute is a trustworthy health information website and is guided by international standards for health information such as HONCode and URAC.
Click here for a review of the Patient Education Institute’s internal policies regarding our X-Plain Online modules.
Click here to see the HONCode certification of the Patient Education Institute.
Content Updates
Our Medical Advisory Board and Medical Director review all medical content on an annual basis and issue updates as needed. We distinguish two types of content updates: critical updates and enhancement updates.
Critical updates revise outdated medical information, which if not withdrawn and replaced, can negatively affect the safety or decision-making of patients and consumers. Less than 1% of X-Plain topics receive critical updates every year.
Enhancement updates refer to changes in text, graphics, illustrations, animations, audio, and streaming that improve the quality of the tutorial. All X-Plain modules are reviewed on an annual basis, and on average about 50% of them receive enhancement updates every year.
Editorial Process
X-Plain interactive modules go through extensive content review, instructional design, and screen design. Our rigorous content review ensures that the material is up-to-date and facilitates unbiased decision making according to current standards of care.
This page gives an overview of the editorial process we use to develop the content of X-Plain modules:
Stage 1 - Writing the Content
Board-certified physicians write the content of most of our X-Plain health care programs. Nurses and other healthcare professionals write modules for which they offer the most expertise in patient education.
Our Medical Advisory Board consists of healthcare professionals who contribute to our libraries. All medical contributors work under editorial guidelines which emphasize unbiased and current standard-of-care language. Contributors sign a Contributor Agreement, disclosing any conflicts of interest and assigning the rights of the X-Plain program to us. The writer of the first script is the Original Author. The Original Author keeps the copyright of his or her original text.
Stage 2 - Reviewing the Content
The Medical Director reviews the content written by the Original Author and determines if it meets our guidelines and if it needs further review by another specialist. The Medical Director may also delete sections that are too technical or add sections that help provide some background to the health topic.
Stage 3 - Instructional Design
The instructional designer reviews content written by the healthcare professionals and organizes it to enhance learning. For example, difficult concepts are presented once simpler ones are explained. The content is divided into sections that are relevant to the consumers. The text is chunked into small pages. Interactive questions with relevant, error-contingent feedback are developed. Finally, graphics and animations are recommended to enhance understanding and engage the learner.
Stage 4 - Editing Content
Before sending the script of a program to healthcare professionals for final proof, our editorial staff reviews the content for grammar, spelling, style, and consistency. The editorial staff also ensures that the readability of the text is acceptable. If healthcare professionals and instructional designers did not simplify sentences enough, further simplification of the language is recommended at this stage.
Stage 5 - Approving the Script
The Original Author and the Medical Director, who constitute the Content Review Board, conduct the final approval of the script. At the discretion of the Medical Director, one or more specialists in the field may be asked to contribute as reviewers. Once the script is approved, the graphic artists, narrators, and programmers proceed with development of the multimedia components.
Stage 6 - Development of Graphics
Our graphic artists develop the medical illustrations. Our graphic artists work closely with the Medical Director, Original Authors, and the instructional designers. Patient Education Institute illustrations are designed to convey an instructional message, not to cause distraction from instructional objectives.
Stage 7 - Multimedia Development
At this stage, the development staff proceeds to assemble the program with text, sound, graphics, and animations. Programmers develop the interface using one of several templates, which signify different instructional strategies. Most X-Plain programs use a tutorial strategy. Each page is designed separately by laying text, graphics, and animations. The narrator records narration of the script and the programmers process it so it can be streamed over the Internet. The multimedia product is uploaded for the Medical Director and Original Author to review.
Stage 8 - Screen Review
The Medical Director and Original Author review each program online. This review consists of checking all narration for proper pronunciation, and the use of appropriate graphics and animations.
Stage 9 - Publication
Publication involves more than 20 steps. The process includes coding and cross-media publication. The topic (or module) is coded and metatags are developed to facilitate the job of search engines and end-user interfaces. They are also coded by international medical coding standards to facilitate integration with evolving electronic medical records.
In cross-media publication, we use the multimedia tutorials and the original script materials to develop publications that utilize other media and instructional formats. This includes illustrated booklets, self-running video presentations, interactive TV programs, and media programs for cell phones.
Step 10 - Translation
English modules are translated either by our Medical Translator for a given language or assigned to a contractual translator. Our Arabic translators perform quality control. We currently contract with a company in Syria for translating the English text of X-Plain to standard modern Arabic.
Step 11 - Translation Medical Review & Approval
Our Medical Director for Arabic Translation reviews and approves all translations. Statistics regarding the USA are either changed to reflect worldwide statistics or are deleted. Measures are changed from the American system to the metric system.
Step 12 - Translation Assembly
The narrator of the translated language narrates the content. A programmer is assigned to process and import narrated files. The programmer also imports the translated text. Localization of graphics is performed to ensure illustrations of people reflect Middle Eastern and Arabic cultures. Only minor localization of the illustrations is performed because graphics are already multi-cultural.
Step 13 -Translation Screen Review
The appropriate Medical Director reviews translated modules on screen. At this stage, minor changes in narration may be recommended.
Step 14 - Publish Translation
Lastly, translated modules are published. This process is similar to the publication of English modules and involves translation of selected metatags and cross-media publication.
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