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Ebrahim S, Kinoo SM, Naidoo M, Van Wyk JM. The use of household items to support online surgical knot-tying skills training: a mixed methods study. BMC MEDICAL EDUCATION 2024; 24:605. [PMID: 38822314 PMCID: PMC11143630 DOI: 10.1186/s12909-024-05549-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/10/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND This study investigated the perceptions and performance of medical students regarding their engagement and learning of a knot-tying skill presented in an online demonstration format due to the emergency remote measures that accompanied COVID-19 restrictions. METHODS Final-year undergraduate medical students were invited to view an online demonstration of a one-handed knot-tying skill and practice the skill using common household items. They recorded their attempts and uploaded them onto the Flipgrid application. Completed attempts were scored using an adapted Objective Structured Assessment of Technical Skill (OSATS) validated tool. We used a mixed-methods sequential explanatory design; data regarding students' engagement was gathered via a short questionnaire, and a Focus Group Discussion (FGD) was conducted to understand their learning experiences better. Descriptive statistics such as proportions and percentages were used to summarize categorical variables and median for continuous variables. Each video attempt was scored independently by two surgeons; reliability was determined using intraclass correlation; statistical tests were conducted at a 5% level of significance. Responses to open-ended survey questions and qualitative data from the FGDs were analysed using thematic analysis. RESULTS Seventy-one students participated in the exercise. Most students (91.5%) expressed confidence in their ability to perform the skill and were able to follow the steps in the video demonstration (83.1%). Median number of times needed to practice before video submission was 7.0 (Interquartile range [IQR] 5.0-10.0). Using the adapted OSATS tool; median scores on student attempts were 19.0 out of 21 (IQR: 17.0-20.0) for Assessor 1 and 18.0 out of 21 (IQR: 17.0-20.0) for Assessor 2, and overall scores showed good reliability between assessors based on intraclass correlation (0.86, 95% CI 0.79-0.90, p < 0.001). Qualitative insights from the students' experiences in learning the skill were generally positive; it was a practical, experiential learning process and they valued the social aspects of learning via Flipgrid. Challenges expressed related to the need for in-person training and formal feedback on how to improve their technique. Suggestions to improve their learning included a request for an interactive session with immediate feedback on attempts, and being able to practice with a friend who would assist with videoing. CONCLUSION Basic knot-tying can be taught with acceptable efficiency and student satisfaction using online methods with items available at home.
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Affiliation(s)
- Sumayyah Ebrahim
- Department of Surgery, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Suman Mewa Kinoo
- Department of Surgery, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Maheshwar Naidoo
- Department of Surgery, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Jacqueline Marina Van Wyk
- Department of Clinical and Professional Practice, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
- Department of Health Sciences Education, University of Cape Town, Observatory, South Africa.
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Jolly AK, Selvarajah D, Micallef J, Torres A, Button D. Adapting the Gamified Educational Networking Online Learning Management System to Test a Decentralized Simulation-Based Education Model to Instruct Paramedics-in-Training on the Emergency Intraosseous Access and Infusion Skill. Cureus 2024; 16:e55493. [PMID: 38571855 PMCID: PMC10988548 DOI: 10.7759/cureus.55493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
Intraosseous (IO) access and infusion is a safe and rapid alternative to intravenous access in obtaining vascular access for administering fluids and drugs. Healthcare professionals, such as primary and advanced care paramedics, use IO access and infusion in emergency circumstances where peripheral intravenous routes are inaccessible. IO access skills require hands-on training, which can be done remotely if the participants have access to simulation, instructions, guidance, and feedback. For the purpose of moving the training outside of the simulation laboratories, we have developed (1) an inexpensive and scalable three-dimensional (3D) printed and silicone-based advanced adult proximal tibial IO access and infusion simulator and (2) a unique learning management system (LMS) for remote simulation-based training. The LMS was built using the Django platform and supports experiential learning by providing access to educational and instructional content (including virtual simulation and serious games), allowing peers to communicate among themselves and with subject-matter experts, provide and receive feedback asynchronously, and engage in learning using gamification elements. The aim of this technical report is to describe the process of development and the final product of the LMS as a research and educational tool to scaffold remote learning of emergency IO skills by paramedics-in-training.
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Affiliation(s)
| | | | | | - Andrei Torres
- Computer Science, Ontario Tech University, Oshawa, CAN
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Pakkasjärvi N, Anttila H, Pyhältö K. What are the learning objectives in surgical training - a systematic literature review of the surgical competence framework. BMC MEDICAL EDUCATION 2024; 24:119. [PMID: 38321437 PMCID: PMC10848354 DOI: 10.1186/s12909-024-05068-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/17/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE To map the landscape of contemporary surgical education through a competence framework by conducting a systematic literature review on learning outcomes of surgical education and the instructional methods applied to attain the outcomes. BACKGROUND Surgical education has seen a paradigm shift towards competence-based training. However, a gap remains in the literature regarding the specific components of competency taught and the instructional methods employed to achieve these outcomes. This paper aims to bridge this gap by conducting a systematic review on the learning outcomes of surgical education within a competence framework and the instructional methods applied. The primary outcome measure was to elucidate the components of competency emphasized by modern surgical curricula. The secondary outcome measure was to discern the instructional methods proven effective in achieving these competencies. METHODS A search was conducted across PubMed, Medline, ProQuest Eric, and Cochrane databases, adhering to PRISMA guidelines, limited to 2017-2021. Keywords included terms related to surgical education and training. Inclusion criteria mandated original empirical studies that described learning outcomes and methods, and targeted both medical students and surgical residents. RESULTS Out of 42 studies involving 2097 participants, most concentrated on technical skills within competency-based training, with a lesser emphasis on non-technical competencies. The effect on clinical outcomes was infrequently explored. CONCLUSION The shift towards competency in surgical training is evident. However, further studies on its ramifications on clinical outcomes are needed. The transition from technical to clinical competence and the creation of validated assessments are crucial for establishing a foundation for lifelong surgical learning.
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Affiliation(s)
- Niklas Pakkasjärvi
- Department of Pediatric Surgery, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland.
- Department of Pediatric Surgery, Section of Urology, University Children's Hospital, Uppsala, Sweden.
| | - Henrika Anttila
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
| | - Kirsi Pyhältö
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
- Centre for Higher and Adult Education, Faculty of Education, Stellenbosch University, Stellenbosch, South Africa
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Reynolds CW, Rooney DM, Jeffcoach DR, Barnard M, Snell MJ, El-Hayek K, Ngam BN, Bidwell SS, Anidi C, Tanyi J, Yoonhee Ryder C, Kim GJ. Evidence supporting performance measures of laparoscopic appendectomy through a novel surgical proficiency assessment tool and low-cost laparoscopic training system. Surg Endosc 2023; 37:7170-7177. [PMID: 37336843 DOI: 10.1007/s00464-023-10182-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Laparoscopic training remains inaccessible for surgeons in low- and middle-income countries, limiting its widespread adoption. We developed a novel tool for assessment of laparoscopic appendectomy skills through ALL-SAFE, a low-cost laparoscopy training system. METHODS This pilot study in Ethiopia, Cameroon, and the USA assessed appendectomy skills using the ALL-SAFE training system. Performance measures were captured using the ALL-SAFE verification of proficiency tool (APPY-VOP), consisting of a checklist, modified Objective Structured Assessment of Technical Skills (m-OSATS), and final rating. Twenty participants, including novice (n = 11), intermediate (n = 8), and expert (n = 1), completed an online module covering appendicitis management and psychomotor skills in laparoscopic appendectomy. After viewing an expert skills demonstration video, participants recorded their performance within ALL-SAFE. Using the APPY-VOP, participants rated their own and three peer videos. We used the Kruskal-Wallis test and a Many-Facet Rasch Model to evaluate (i) capacity of APPY-VOP to differentiate performance levels, (ii) correlation among three APPY-VOP components, and (iii) rating differences across groups. RESULTS Checklist scores increased from novice (M = 21.02) to intermediate (M = 23.64) and expert (M = 28.25), with differentiation between experts and novices, P = 0.005. All five m-OSATS domains and global summed, total summed, and final rating discriminated across all performance levels (P < 0.001). APPY-VOP final ratings adequately discriminated Competent (M = 2.0), Borderline (N = 1.8), and Not Competent (M = 1.4) performances, Χ2 (2,85) = 32.3, P = 0.001. There was a positive correlation between ALL-SAFE checklist and m-OSATS summed scores, r(83) = 0.63, P < 0.001. Comparison of ratings suggested no differences across expertise levels (P = 0.69) or location (P = 0.66). CONCLUSION APPY-VOP effectively discriminated between novice and expert performance in laparoscopic appendectomy skills in a simulated setting. Scoring alignment across raters suggests consistent evaluation, independent of expertise. These results support the use of APPY-VOP among all skill levels inside a peer rating system. Future studies will focus on correlating proficiency to clinical practice and scaling ALL-SAFE to other settings.
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Affiliation(s)
| | - Deborah M Rooney
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | | | - Melanie Barnard
- Department of Surgery, Southern Illinois University, Carbondale, IL, USA
| | | | - Kevin El-Hayek
- Department of Surgery, The MetroHealth System, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | | | - Chioma Anidi
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - John Tanyi
- Mbingo Baptist Hospital, Mbingo, Cameroon
| | | | - Grace J Kim
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, SPC 5331, Ann Arbor, MI, 48109-5331, USA.
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Mao BP, Teichroeb ML, Lee T, Wong G, Pang T, Pleass H. Is Online Video-Based Education an Effective Method to Teach Basic Surgical Skills to Students and Surgical Trainees? A Systematic Review and Meta-analysis. JOURNAL OF SURGICAL EDUCATION 2022; 79:1536-1545. [PMID: 35933308 PMCID: PMC9356715 DOI: 10.1016/j.jsurg.2022.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/13/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Online education has been increasingly utilized over the past decades. The COVID-19 pandemic accelerated the transition of conventional face-to-face curricula to online platforms, with limited evidence for its teaching efficacy. This systematic review aims to assess the effectiveness of online video-based education compared with standard conventional education in teaching basic surgical skills to surgical trainees and students undergoing medical training. METHODS We performed a literature search in Embase, Medline, Cochrane CENTRAL and Scopus from inception until February 2022. Studies included were randomised controlled trials (RCTs) and observational studies. We included randomised controlled trials only for meta-analysis. The primary outcome was surgical skill proficiency. The secondary outcomes were participant perception, confidence and satisfaction. Two authors independently assessed the search results for eligibility, extracted the data and assessed the risk of bias using the Cochrane Risk of Bias tool 2. Where appropriate, we performed random effects meta-analyses of the pooled study data to calculate a standardized mean difference. RESULTS A total of 11 studies met the inclusion criteria totaling 715 participants; 603 were included in qualitative analysis and 380 in meta-analysis. All included studies were assessed as having a low risk of bias. The majority of studies found no significant difference between conventional and video-based education in teaching basic surgical skills, three studies found video-based education was superior and one study found conventional education was superior. There was no statistically significant difference in skill proficiency between the two groups (standardized mean difference of -0.02 (95% CI: -0.34, 0.30); p=0.90). Video-based education results in an equivalent improvement in confidence and satisfaction rates. Additional benefits of video-based education include convenience, accessibility and efficiency. CONCLUSIONS Basic surgical skills can be taught as effectively through online video-based education as conventional teaching methods. Online education should be utilized as an adjunct to medical curricula beyond the COVID-19 era.
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Affiliation(s)
- B P Mao
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - M L Teichroeb
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - T Lee
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - G Wong
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
| | - T Pang
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - H Pleass
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
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Alshaalan ZM. The Effect of Using Video Simulation and Hands-on Simulation Training on Preclinical Medical Students’ Confidence in Dermatological Suturing Skills. Clin Cosmet Investig Dermatol 2022; 15:2045-2050. [PMID: 36199386 PMCID: PMC9527699 DOI: 10.2147/ccid.s369359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/05/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Ziad Mansour Alshaalan
- Department of Internal Medicine, Division of Dermatology, College of Medicine, Jouf University, Sakaka, Aljouf, Saudi Arabia
- Correspondence: Ziad Mansour Alshaalan, Department of Internal Medicine, Division of Dermatology, College of Medicine, Jouf University, Sakaka, Aljouf, 72388, Saudi Arabia, Tel +966-566000909, Email
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Wahab S, Dubrowski A. Adapting the Gamified Educational Networking (GEN) Learning Management System to Deliver a Virtual Simulation Training Module to Determine the Enhancement of Learning and Performance Outcomes. Cureus 2022; 14:e26332. [PMID: 35911359 PMCID: PMC9313523 DOI: 10.7759/cureus.26332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/22/2022] Open
Abstract
Microtomy is a medical laboratory sciences procedure that medical laboratory technologists (MLTs) use to cut tissues for microscopic examination. Due to safety concerns and the potential to destroy tissue samples, learners must perform the procedure correctly. In order to allow for safe and controlled learning, this procedure should be conducted in a simulated setting before attempting with human tissues. The objective of this study is to describe the development and user-based evaluation of a virtual simulation training module. A research group developed the virtual simulation training module's content and design, and a local MLT expert provided the content. Nine students enrolled in a university-based medical laboratory sciences program provided feedback about the module. The results demonstrated that the virtual simulation training module was an effective and user-friendly learning tool for the medical laboratory sciences program. Although more validity and efficacy testing are required in the future, the students indicated a potential to use this module to prepare future students for hands-on exercise in a simulation laboratory setting.
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Nathan A, Fricker M, Georgi M, Patel S, Hang MK, Asif A, Sinha A, Mullins W, Shea J, Hanna N, Monks M, Peprah D, Sharma A, Ninkovic-Hall G, Lamb BW, Kelly J, Sridhar A, Collins JW. Virtual Interactive Surgical Skills Classroom: A Parallel-group, Non-inferiority, Adjudicator-blinded, Randomised Controlled Trial (VIRTUAL). JOURNAL OF SURGICAL EDUCATION 2022; 79:791-801. [PMID: 34857499 DOI: 10.1016/j.jsurg.2021.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/05/2021] [Accepted: 11/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study evaluated the efficacy of virtual classroom training (VCT) in comparison to face-to-face training (FFT) and non-interactive computer-based learning (CBL) for basic surgical skills training. DESIGN This was a parallel-group, non-inferiority, prospective randomised controlled trial with three intervention groups conducted in 2021. There were three intervention groups with allocation ratio 1:1:1. Outcome adjudicators were blinded to intervention assignment. Interventions consisted of 90-minute training sessions. VCT was delivered via the BARCO weConnect platform, FFT was provided in-person by expert instructors and CBL was carried out by participants independently. The primary outcome was post-intervention Objective Structured Assessment of Technical Skills score, adjudicated by two experts and adjusted for baseline proficiency. The assessed task was to place three interrupted sutures with hand-tied knots. SETTING This multicentre study recruited from five medical schools in London. PARTICIPANTS Inclusion criteria were medical student status and access to a personal computer and smartphone. One hundred fifty-nine eligible individuals applied online. Seventy-two participants were randomly selected and stratified by subjective and objective suturing experience prior to permuted block randomization. RESULTS Twenty-four participants were allocated to each intervention, all were analysed per-protocol. The sample was 65.3% female with mean age 21.3 (SD 2.1). VCT was non-inferior to FFT (adjusted difference 0.44, 95% CI: -0.54 to 1.75, delta 0.675), VCT was superior to CBL (adjusted difference 1.69, 95% CI: 0.41-2.96) and FFT was superior to CBL (adjusted difference 1.25, 95% CI: 0.20-2.29). The costs per-attendee associated with VCT, FFT and CBL were £22.15, £39.69 and £16.33 respectively. Instructor hours used per student for VCT and FFT were 0.25 and 0.75, respectively. CONCLUSIONS VCT provides greater accessibility and resource efficiency compared to FFT, with similar educational benefit. VCT has the potential to improve global availability and accessibility of surgical skills training.
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Affiliation(s)
- Arjun Nathan
- Division of Surgery and Interventional Science, University College London, London, United Kingdom.
| | - Monty Fricker
- School of Medicine, Newcastle University, Newcastle, United Kingdom
| | - Maria Georgi
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Sonam Patel
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Man Kien Hang
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Aqua Asif
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Amil Sinha
- School of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - William Mullins
- School of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jessie Shea
- School of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Nancy Hanna
- School of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Massimo Monks
- Department of Surgery, North Middlesex University Hospitals NHS Foundation Trust, London, United Kingdom
| | - David Peprah
- Department of Surgery, North Middlesex University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Akash Sharma
- Department of Radiology, Imperial College London, London, United Kingdom
| | - George Ninkovic-Hall
- Department of Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Benjamin W Lamb
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - John Kelly
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Ashwin Sridhar
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Justin W Collins
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
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Chen WK, Chang JR, Chen LS, Hsu RY. Using refined kano model and decision trees to discover learners' needs for teaching videos. MULTIMEDIA TOOLS AND APPLICATIONS 2022; 81:8317-8347. [PMID: 35125926 PMCID: PMC8807013 DOI: 10.1007/s11042-021-11744-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 09/06/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
With the advancement of technology and the spread of the COVID19 epidemic, learning can no longer only be done through face-to-face teaching. Numerous digital learning materials have appeared in large numbers, changing people's learning mode. In the era of information explosion, how to capture the learners' attention to teaching videos and improve learning effectiveness is the common goal of every designer of e-leaning teaching content. Previous researches focused on the analysis of learning effectiveness and satisfaction. Instructional designers only provided design elements with high learning effectiveness or high satisfaction, and lacked in-depth analysis of the learners' perspectives. The opinions of these e-learning users are often the key to the success of online teaching videos. Therefore, this study aims at the design elements that will be used in the teaching film. The operation mode of the piano mechanism will be employed as the content of the teaching film. Based on eight elements including arrow cueing, dynamic arrow cueing, spreading-color cueing, contrary to cueing, font style, color application, anthropomorphic, and audiovisual complementarity, we use Refined Kano Model to analyze learners' needs of categorization of each element, and discover learners' expectations for teaching videos. In addition, this study also conducts in-depth data analysis through decision trees algorithm, and stratification analyses using different variables (such as design expertise, using frequency, and usage experience, etc.) to find out the key design factors that affect learners' learning. Depending on the learner's background, the use of e-learning experience, using frequency, and the length of the learning video, our results could provide for reference when designing teaching videos. Instructional designers can better understand how to effectively use design elements, so that the teaching videos can achieve the best learning effect.
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Affiliation(s)
- Wen-Kuo Chen
- Department of Marketing and Logistics Management, Chaoyang University of Technology, Taichung, 413310 Taiwan
| | - Jing-Rong Chang
- Department of Information Management, Chaoyang University of Technology, Taichung, 413310 Taiwan
| | - Long-Sheng Chen
- Department of Information Management, Chaoyang University of Technology, Taichung, 413310 Taiwan
| | - Rui-Yang Hsu
- Department of Information Management, Chaoyang University of Technology, Taichung, 413310 Taiwan
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Vervoort D, Fiedler AG. Virtual reality, e-learning, and global cardiac surgical capacity-building. J Card Surg 2021; 36:1835-1837. [PMID: 33772865 DOI: 10.1111/jocs.15498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Dominique Vervoort
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amy G Fiedler
- Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin, Madison, Wisconsin, USA
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