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Background: The effects of many treatments in healthcare are determined by factors other than the treatment itself. Patients' expectations and the relationship with their healthcare provider can significantly affect treatment outcomes and thereby play a major role in eliciting placebo and nocebo effects. We aim to develop and evaluate an innovative communication training, consisting of an e-learning and virtual reality (VR) training, for healthcare providers across all disciplines, to optimize placebo and minimize nocebo effects through healthcare provider-patient communication. The current paper describes the development, mid-term evaluation, optimization, and final evaluation of the communication training, conducted in The Netherlands. Methods: The development of both the e-learning and the VR training consisted of four phases: 1) content and technical development, 2) mid-term evaluation by healthcare providers and placebo/communication researchers, 3) optimization of the training, and 4) final evaluation by healthcare providers. To ensure the success, applicability, authenticity, and user-friendliness of the communication training, there was ongoing structural collaboration with healthcare providers as future end users, experts in the field of placebo/communication research, and educational experts in all phases. Results: Placebo/communication researchers and healthcare providers evaluated the e-learning positively (overall 7.9 on 0–10 scale) and the content was perceived as useful, accessible, and interesting. The VR training was assessed with an overall 6.9 (0–10 scale) and was evaluated as user-friendly and a safe method for practicing communication skills. Although there were some concerns regarding the authenticity of the VR training (i.e. to what extent the virtual patient reacts like a real patient), placebo and communication researchers, as well as healthcare providers, recognized the significant potential of the VR training for the future. Conclusions: We have developed an innovative and user-friendly communication training, consisting of an e-learning and VR training (2D and 3D), that can be used to teach healthcare providers how to optimize placebo effects and minimize nocebo effects through healthcare provider-patient communication. Future studies can work on improved authenticity, translate the training into other languages and cultures, expand with additional VR cases, and measure the expected effects on providers communication skills and subsequently patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Mastering fractions seems among the most critical mathematical skills for students to acquire in school as fraction understanding significantly predicts later mathematic achievements, but also broader academic and vocational prospects. As such, identifying longitudinal predictors of fraction understanding (e.g., mastery of numbers and operations) is highly relevant. However, almost all existing studies identifying more basic numerical skills as predictors of fraction understanding rest on data acquired in face‐to‐face testing—mostly in classrooms. Objectives: In this article, we evaluated whether results obtained in these previous studies generalized to data from the curriculum‐based online learning environment Bettermarks for mathematics used in schools in the Netherlands. Methods: We considered data from more than 5000 students who solved over 1 million mathematical problem sets on basic mathematical skills, fractions, but also algebra. Results and Conclusions: In line with previous findings, we found that fraction understanding was predicted significantly by more basic mathematical skills. Our analyses also indicated that algebra achievement was predicted significantly by fraction understanding beyond influences of more basic mathematical skills. Implications: Together, these findings generalized previous results based on face‐to‐face testing to the context of data from online learning environments and thus, indicate that data from such large‐scale online learning environments may well qualify to provide significant insights into the hierarchical development of mathematical skills. Lay Description: What is already known about this topic: Understanding fractions is one of the most difficult mathematical skill for students to learn in school.Longitudinal studies using face‐to‐face testing indicated that fraction understanding as well as achievements in algebra can robustly be predicted by prior mathematics skills. What this paper adds: We evaluated data from more than 5,000 Dutch students who performed over 1 million curriculum‐based mathematical problem sets in an online learning environment.Our analyses showed that fraction understanding as well as achievements in algebra and can be predicted by prior mathematics skills. Implications for practitioners: These results indicated that previous results from face‐to‐face testing generalize to data obtained from large‐scale online learning environments.Thus, these results open up a new avenue for research using online learning environments on the development of mathematical skills. [ABSTRACT FROM AUTHOR]