Medical education as a science: the quality of evidence for computer-assisted instruction

Impact of COVID-19 on Medical Students' Learning Behaviours, Clinical Training, Performance as Future Medical Professionals, and Perceived Stress: A Cross-Sectional Web Survey

INTRODUCTION

The COVID-19 pandemic prompted the implementation of online education worldwide but the impact on medical student learning in the Caribbean is unclear.

AIM

The study aims to assess the impact of COVID-19 on medical students' learning behaviours, clinical training, perception of performance as future medical professionals, and perceived stress.

METHODS

A cross-sectional web survey on selected variables, utilising purposive sampling amongst all year four and year five undergraduate medical students in the University of the West Indies in Trinidad was conducted. Quantitative data was examined using χ2, Median (IQR) and qualitative information from open-ended questions was integrated with the presentation of the results.

RESULTS

A total of 145 medical students responded of which 114 (78.6%, p<0.01) indicated that online learning strategies had brought a change in their learning behaviours and 136 (93.8%, p<0.01) respondents indicated that COVID-19 had affected the quality of their training, in most cases negatively. In the perception of future career performance, 90 (62.1%, p<0.01) respondents indicated that they felt a lack of preparation for working as a physician at the end of their training. It was found that 137 (94.5 %, p<0.01) fell into the moderate to high stress category.

CONCLUSIONS

COVID-19 had a significant impact on learning behaviours, clinical training and perception of performance in future career. Moderate to high levels of stress were observed among these students. These findings underscore the need for medical schools to adopt hybrid models that balance online education with practical clinical exposure to mitigate learning and psychological challenges experienced during the pandemic.

Simulator Education Initiatives for On-Campus Practical Training in Nuclear Medicine Technology

Because nuclear medicine diagnostic equipment has not been installed at our educational institution, we had not been able to incorporate nuclear medicine techniques into on-campus training until now. Methods: We have introduced a diagnostic image processing simulator to replace nuclear medicine diagnostic equipment. The simulator was used to conduct on-campus practical training on nuclear medicine technology. We also conducted a questionnaire survey of students regarding their experience with on-campus practical training using the simulators. Results: The survey results revealed that the on-campus practical training using simulators deepened students' understanding of the content they had encountered in classroom lectures. Conclusion: We successfully implemented on-campus practical training in nuclear medicine technology using a diagnostic image-processing simulator. According to the results of our questionnaire, it is possible to provide on-campus practical training to students using simulators that enhance understanding of nuclear medicine technology.

Does E-learning Facilitate Medical Education in Pediatric Neurology?

BACKGROUND

E-learning has become commonplace in medical education. Incorporation of multimedia, clinical cases, and interactive elements has increased its attractiveness over textbooks. Although there has been an expansion of e-learning in medicine, the feasibility of e-learning in pediatric neurology is unclear. This study evaluates knowledge acquisition and satisfaction using pediatric neurology e-learning compared to conventional learning.

METHODS

Residents of Canadian pediatrics, neurology, and pediatric neurology programs and medical students from Queens University, Western University, and the University of Ottawa were invited to participate. Learners were randomly assigned two review papers and two ebrain modules in a four-topic crossover design. Participants completed pre-tests, experience surveys, and post-tests. We calculated the median change in score from pre-test to post-test and constructed a mixed-effects model to determine the effect of variables on post-test scores.

RESULTS

In total, 119 individuals participated (53 medical students; 66 residents). Ebrain had a larger positive change than review papers in post-test score from pre-test score for the pediatric stroke learning topic but a smaller positive change for Duchenne muscular dystrophy, childhood absence epilepsy, and acute disseminated encephalomyelitis. Learning topics showed statistical relationship to post-test scores (p = 0.04). Depending on topic, 57-92% (N = 59-66) of respondents favored e-learning over review article learning.

CONCLUSIONS

Ebrain users scored higher on post-tests than review paper users. However, the effect is small and it is unclear if it is educationally meaningful. Although the difference in scores may not be substantially different, most learners preferred e-learning. Future projects should focus on improving the quality and efficacy of e-learning modules.

Are students performing the same in E-learning and In-person education? An introspective look at learning environments from an Iranian medical school standpoint

INTRODUCTION

This study investigated medical students' intended learning outcomes based on e-learning and in-person education.

METHODS

In this cross-sectional comparative analytical study, a group of 126 undergraduate medical students' intended learning outcomes under two different teaching methods, including e-learning and in-person, were repeatedly measured based on the census sampling method. Participants were in the preclinical curriculum phase (physiopathology) at Mashhad University of Medical Sciences (MUMS), Iran. Due to expert panel opinion, the same medical teachers and similar difficulty of lessons were considered in two investigated academic semesters. In addition, difficulty and discrimination indexes of formative and summative assessments were controlled for two study groups. The students' learning outcome index was the knowledge test scores participants received in the relevant lessons of the General Medicine (GM) curriculum preclinical courses.

RESULTS

The findings indicated that students learning outcomes were significantly higher during e-learning than in in-person education for all examined variables (P < 0.05). Moreover, the difference between students' Grade Point Average (GPA) categories among the two groups was significant (P = 0.022). Students with a GPA of less than 14 experienced higher increments in their average scores after the e-learning compared to in-person education. Compared to face-to-face courses, improvements in pharmacology, theoretical semiology, and pathology scores after e-learning courses were statistically significant (P < 0.001). The differences in mean scores related to practical pathology and semiology in the two approaches were not statistically significant, P = 0.624 and P = 0.149, respectively. Furthermore, the overall students' average scores increased significantly during e-learning versus in-person education (P < 0.001).

CONCLUSION

We concluded that e-learning could be appreciated as a successful method of medical education and can be used as an alternative educational method. However, considering the importance of practical or clinical courses in medical education, further research about the efficacy of the e-learning approach is highly recommended.

Effect of distance learning on the quality of life, anxiety and stress levels of dental students during the COVID-19 pandemic

BACKGROUND

The long-term psychological effects of COVID-19 on dental students are unclear. The aim of this cross-sectional online study was to investigate the psychological effects of the COVID-19 pandemic on dental students.

METHOD

The Quality of Life Scale (WHOQOL-BREF) was sent to all dental students through Google Forms to evaluate their quality of life (QoL), and the DASS-21 scale was used to evaluate their psychosocial status due to distance learning during the COVID-19 pandemic. The answers were analyzed both on the basis of year of education and type of education (online versus classroom learning). One-way ANOVA was used for comparison of students in the different years of education; post hoc LSD test was used for pairwise comparisons. Sample t-test was used to compare the two groups separated as classroom/face-to-face learning and distance/online learning.

RESULT

The questionnaire was completed by 580 students with a response rate of 87.74%. According to the QoL scale results, there was no significant difference between the groups regarding general health, physical health, and psychology, both between different years and learning methods (p > 0.05). According to the results of the DASS-21 scale, anxiety and depression in the 3rd year students were significantly higher than the other years. The stress level of the 2nd year students was statistically significantly different from the other years (p < 0.05). Evaluation of anxiety, stress and the QoL showed an overall detrimental effect of distance learning on the dental students, although the evaluation did not reach statistical significance.

CONCLUSION

Anxiety, stress and factors affecting the quality of life negatively affected dental students who received online/distance learning, although the difference did not reach statistical significance when compared to students who received in-classroom learning.

The Impact of the COVID-19 Pandemic on Romanian Postgraduate Periodontal Residency Teaching: Past Experience, Present Imperatives and Future Considerations in a Multicentric Evaluation

The aims of this study were to identify the challenges in periodontology postgraduate residency programs during the COVID-19 pandemic by identifying the modifications of educational instruments, to evaluate the impact of hybrid education on periodontology postgraduate programs in terms of resident-centred outcomes, and to evaluate the education efficiency of an innovative teaching approach. Resident doctors from three Romanian dental faculties were included in study groups based on the intensity of clinical training. A web-based questionnaire was used to collect information on residents’ perception about teaching activity. Important educational changes were identified. Moreover, residents learned a periodontal procedure through online training and then performed it on preclinical models three times. The working times were recorded. Statistical analysis was performed. Resident doctors were unsatisfied with clinical practice during the pandemic year, but they positively valued the development of online courses. Learning efficiency improved by repeating the same procedure on preclinical models, as proved by the significant decrease of the working times. E-learning was appreciated as an important component of the new hybrid teaching approach. Reorganization and further emphasis on both preclinical and medical practice, targeted to aid residents perform more accurate and efficient procedures, are recommended.

Students' initial perspectives on online learning experience in China during the COVID-19 outbreak: expanding online education for future doctors on a national scale

BACKGROUND

During the early stage of COVID-19 outbreak in China, most medical undergraduate programs have to eventually embrace the maneuver of transferring to nearly 100% online-learning as a new routine for different curricula. And there is a lack of empirical evidence of effective medical education curriculum that has been completely implemented in an online format. This study summarizes medical students' perspectives regarding online-learning experience during the COVID-19 outbreak and presents reflection on medical education.

METHODS

From February 21st to March 14th, 2020, the authors conducted survey of a nationally representative sample of undergraduate medical students from 90 medical schools in China. Participant demographics and responses were tabulated, and independent sample t-tests as well as multiple logistic regression models were used to assess the associations of demographic characteristics, prior online learning experience, and orientation with students' perspectives on the online learning experience.

RESULTS

Among 118,030 medical students participated in the survey (response rate 52.4%), 99,559 provided valid data for the analysis. The sample is fairly nationally representative. 65.7% (65,389/99,559) supported great orientation and 62.1% (61,818/99,559) reported that they were satisfied with the ongoing online-learning experience. The most common problem students would encounter was the network congestion (76,277/99,559; 76.6%). Demographics, learning phases, and academic performance were associated with online-learning engagement and perceptions. Formal orientation and prior PU (perceived usefulness of online learning) were significantly positively associated with the satisfaction and evaluation of the online learning experience (p <  0.001).

CONCLUSIONS

Data from this national survey indicates a relatively positive role of online learning as a formal teaching/learning approach in medical education. Considerations should be made regarding such application in aspects of students' different learning phases. We suggest that further policy interventions should be taken from technological, organizational, environmental, as well as individual aspects, to help improve the outcome of online learning for future doctors.

Changing methods of education during a pandemic: questionnaire survey about examinations for nuclear medicine technology at educational institutions in Japan

Coronavirus disease 2019 (COVID-19) has spread around the world. Its effects go far beyond health care: education has to be conducted so as to prevent infection among students and faculty. Accordingly, changes have occurred in Japan’s educational institutions, including methods of preparing students for examinations for nuclear medicine. To assess the quality of training for radiologic technologists, we investigated the related changes undertaken at educational institutions. We investigated the lecture format for teaching nuclear medicine technology at Japanese institutions during COVID-19 and efforts to ensure the quality of conventional education. Methods: We sent a questionnaire to 19 Japanese institutions. It addressed the lecture format and initiatives in examinations for nuclear medicine technology in the first and second semesters of 2020. Results: We obtained responses from 17 institutions. In the first semester of 2020, the lecture format for nuclear medicine technology included remote, hybrid (combination of remote and face-to-face), and video-on-demand lectures. To reinforce the effect of the new teaching formats, institutions adopted various methods, such as enhancing the possibility of allowing students to ask questions, increasing the number of quizzes during lectures, delivering lectures to YouTube, and introducing an e-learning system. In the second semester of 2020, the lecture format included face-to-face, remote, hybrid, and video-on-demand lectures. In that second semester, the number of institutions providing face-to-face lectures while taking thorough measures against infection showed a marked increase. Conclusion: The institutions introduced various educational techniques and initiatives. They prioritized students’ understanding of lecture content and applied what they considered the best teaching methods. Sharing information about the changes adopted at different institutions should help promote good radiologic technologists—even during a pandemic.

COVID-19 AND DENTAL DISTANCE-BASED EDUCATION: students' perceptions in an Italian University

BACKGROUND

The aim of the study was to analyze the perception of dental faculties students regarding the complete transition to distance-based education (DE) and the adaptation of this educational strategy, due to Covid-19 pandemic. A questionnaire to be completed anonymously was submitted online to students attending the faculties of Dentistry and Oral Hygiene at Sapienza, University of Rome, after the end of distance lessons. The collected data were processed statistically, providing descriptive data and analysis of correlation of the most significant parameters, using Chi-squared test, Cramér V and Pearson φ2, Goodman and Kruskal's γ and λ and Kendall's τb. The level of statistical significance was p < 0.05.

RESULTS

A total of 314 students participated in the survey. The overall level of satisfaction on a ten- point scale was 5.39 ± 2.59 for Oral Hygiene students and 6.15 ± 2.98 for Dentistry students. The most common complaints were the lack of a structured online curriculum, less interaction with professors and a lower level of attention. On the basis of the responses, scored using Likert-type Scale, oral Hygiene students reported statistically higher level of physical fatigue(p = 0.0189), a lower level of attention (p = 0.0136) and of the quality and quantity of acquired knowledge during distance education (p = 0.0392), compared to Dentistry students. Level of perceived stress and quality and quantity of acquired knowledge (γ = 0.81 and τb =0.56) and quality and quantity of acquired knowledge and fear of a decrease in knowledge (γ = 0.76 and τb =0.54) are associated variables.

CONCLUSION

Students' feedback is essential to solve the key issues emerged from the questionnaire. New educational models should be define in order to ensure that distance education could be effective, meeting the learning needs of the students, and could not be a merely "online shift" of traditional methods, used as an alternative of live education.

Exploring the Cost of eLearning in Health Professions Education: Scoping Review

BACKGROUND

Existing research on the costs associated with the design and deployment of eLearning in health professions education is limited. The relative costs of these learning platforms to those of face-to-face learning are also not well understood. The lack of predefined costing models used for eLearning cost data capture has made it difficult to complete cost evaluation.

OBJECTIVE

The key aim of this scoping review was to explore the state of evidence concerning cost capture within eLearning in health professions education. The review explores the available data to define cost calculations related to eLearning.

METHODS

The scoping review was performed using a search strategy with Medical Subject Heading terms and related keywords centered on eLearning and cost calculation with a population scope of health professionals in all countries. The search was limited to articles published in English. No restriction was placed on literature publication date.

RESULTS

In total, 7344 articles were returned from the original search of the literature. Of these, 232 were relevant to associated keywords or abstract references following screening. Full-text review resulted in 168 studies being excluded. Of these, 61 studies were excluded because they were unrelated to eLearning and focused on general education. In addition, 103 studies were excluded because of lack of detailed information regarding costs; these studies referred to cost in ways either indicating cost favorability or unfavorability, but without data to support findings. Finally, 4 studies were excluded because of limited cost data that were insufficient for analysis. In total, 42 studies provided data and analysis of the impact of cost and value in health professions education. The most common data source was total cost of training (n=29). Other sources included cost per learner, referring to the cost for individual students (n=13). The population most frequently cited was medical students (n=15), although 12 articles focused on multiple populations. A further 22 studies provide details of costing approaches for the production and delivery of eLearning. These studies offer insight into the ways eLearning has been budgeted and project-managed through implementation.

CONCLUSIONS

Although cost is a recognized factor in studies detailing eLearning design and implementation, the way cost is captured is inconsistent. Despite a perception that eLearning is more cost-effective than face-to-face instruction, there is not yet sufficient evidence to assert this conclusively. A rigorous, repeatable data capture method is needed, in addition to a means to leverage existing economic evaluation methods that can then test eLearning cost-effectiveness and how to implement eLearning with cost benefits and advantages over traditional instruction.

Distance learning in clinical medical education amid COVID-19 pandemic in Jordan: current situation, challenges, and perspectives

BACKGROUND

As COVID-19 has been declared as a pandemic disease by the WHO on March 11th, 2020, the global incidence of COVID-19 disease increased dramatically. In response to the COVID-19 situation, Jordan announced the emergency state on the 19th of March, followed by the curfew on 21 March. All educational institutions have been closed as well as educational activities including clinical medical education have been suspended on the 15th of March. As a result, Distance E-learning emerged as a new method of teaching to maintain the continuity of medical education during the COVID-19 pandemic related closure of educational institutions. Distance E-Learning is defined as using computer technology to deliver training, including technology-supported learning either online, offline, or both. Before this period, distance learning was not considered in Jordanian universities as a modality for education. This study aims to explore the situation of distance E-learning among medical students during their clinical years and to identify possible challenges, limitations, satisfaction as well as perspectives for this approach to learning.

METHODS

This cross-sectional study is based on a questionnaire that was designed and delivered to medical students in their clinical years. For this study, the estimated sample size (n = 588) is derived from the online Raosoft sample size calculator.

RESULTS

A total of 652 students have completed the questionnaire, among them, 538 students (82.5%) have participated in distance learning in their medical schools amid COVID-19 pandemic. The overall satisfaction rate in medical distance learning was 26.8%, and it was significantly higher in students with previous experience in distance learning in their medical schools as well as when instructors were actively participating in learning sessions, using multimedia and devoting adequate time for their sessions. The delivery of educational material using synchronous live streaming sessions represented the major modality of teaching and Internet streaming quality and coverage was the main challenge that was reported by 69.1% of students.

CONCLUSION

With advances in technologies and social media, distance learning is a new and rapidly growing approach for undergraduate, postgraduate, and health care providers. It may represent an optimal solution to maintain learning processes in exceptional and emergency situations such as COVID-19 pandemic. Technical and infrastructural resources reported as a major challenge for implementing distance learning, so understanding technological, financial, institutional, educators, and student barriers are essential for the successful implementation of distance learning in medical education.

Does the virtual refractor patient-simulator improve student competency when refracting in the consulting room?

BACKGROUND

The use of patient simulators in ophthalmic education appears limited. This study examines the effects of the addition of the 'Virtual Refractor' patient simulator learning activity into a short unit preparing students to determine the power of the spectacle lenses required by patients in a clinic.

METHODS

Twenty-four year one optometry students were randomly assigned to either the simulator-intervention group (n = 12) or the non-intervention group. All students attended tutorials on refraction and the use of a refractor-head. Simulator-intervention students additionally attended a tutorial on the Virtual Refractor. All answered a questionnaire concerning time spent studying, perceived knowledge and confidence. Twenty-four short-sighted patients were recruited. Two refractions per student were timed and the accuracy compared with that of an experienced optometrist.

RESULTS

Ten students from each group completed the study. Students who used the simulator were significantly (p < 0.05) more accurate at a clinical level (within 0.22 ± 0.22 DS, 95 per cent CI 0.12-0.32) than those who did not (within 0.60 ± 0.67 DS, 95 per cent CI 0.29-0.92) and 13 per cent quicker (4.7 minutes, p < 0.05). Students who used the simulator felt more knowledgeable (p < 0.05) and confident (p < 0.05), but had spent more time reading about refraction and practised on the Virtual Refractor at home for 5.7 ± 1.3 hours.

CONCLUSION

The Virtual Refractor has many features of high-fidelity medical simulation known to lead to effective learning and it also offers flexible independent learning without a concomitant increase in the student time-burden. The improved accuracy and speed on first patient encounters found in this study validates the use of this patient simulator as a useful bridge for students early in training to successfully transfer theoretical knowledge prior to entering the consulting room. The translational benefits resulting from compulsory learning activities on a patient simulator can lead to reduced demands on infrastructure and clinical supervision.

Case-based online learning for medical undergraduates

Online learning is a tool for teaching and assessing students but to date it has been under-utilised in psychiatry. This article outlines the evidence base for such approaches and gives an illustrative account of developing modules for medical undergraduates on the topic of alcohol use and misuse. This may act as a guideline for the development of other psychiatric teaching modules.

Computer-Assisted Learning Applications in Health Educational Informatics: A Review

Computer-assisted learning (CAL) as a health informatics application is a useful tool for medical students in the era of expansive knowledge bases and the increasing need for and the consumption of automated and interactive systems. As the scope and breadth of medical knowledge expand, the need for additional learning outside of lecture hours is becoming increasingly important. CAL can be an impactful adjunct to conventional methods that currently exist in the halls of learning. There is an increasing body of literature that suggests that CAL should be a commonplace and the recommended method of learning for medical students. Factors such as technical issues that hinder the performance of CAL are also evaluated. We conclude by encouraging the use of CAL by medical students as a highly beneficial method of learning that complements and enhances lectures and provides intuitive, interactive modulation of a self-paced curriculum based on the individual's academic abilities.

A Prospective Cohort Study Using e-Learning Modules as a Supplemental Teaching Resource for Obstetrics and Gynaecology Clerkship Students

OBJECTIVE

Increasing enrolment in medical schools in Canada has necessitated the development of distributed clinical learning sites to provide appropriate clinical experience. The Faculty of Medicine at Dalhousie University has clinical clerkship sites distributed across Nova Scotia, New Brunswick, and Prince Edward Island, with diverse educational exposures. This study was designed to examine the influence of online learning modules, developed to standardize learning across education sites during the clinical clerkship, on the acquisition of knowledge by medical students during their obstetrics and gynaecology clerkship rotation.

METHODS

The third year medical school class was divided into two natural cohorts for the purposes of this study. Group 1 had their obstetrics and gynaecology rotation from September 2012 to March 2013 (n = 54), and Group 2 had their rotation from April to September 2013 (n = 60). All students were given the opportunity to complete an online formative examination before their summative multiple choice examination; only Group 2 students had access to six obstetrics and gynaecology e-learning modules, upon which the formative examination was based.

RESULTS

Forty-seven students in Group 1 (87%) and 45 students in Group 2 (75%) completed the formative examination, with an overall participation rate of 81%. There was no difference in median scores between Group 1 (score 9, IQR 8 to 10) and Group 2 (score 9, IQR 8 to 11, P = 0.08).

CONCLUSION

Having access to six e-learning modules did not improve the third year medical students' scores on a formative examination completed before their summative multiple choice examination.

Perceived outcomes of web-based modules designed to enhance athletic trainers' knowledge of evidence-based practice

CONTEXT

The release of evidence-based practice (EBP) Web-based learning modules to the membership of the National Athletic Trainers' Association has provided athletic trainers (ATs) the opportunity to enhance their knowledge of the various EBP concepts. Whereas increasing the knowledge of EBP among ATs is important, assessing whether this newfound knowledge is being translated into clinical practice and didactic education is crucial.

OBJECTIVE

To explore the effectiveness of an educational intervention regarding EBP on the didactic instruction patterns of athletic training educators and the clinical practice behaviors of clinicians.

DESIGN

Qualitative study.

SETTING

Individual telephone interviews.

PATIENTS OR OTHER PARTICIPANTS

A total of 25 ATs (12 educators, 13 clinicians; experience as an AT = 16.00 ± 9.41 years) were interviewed.

DATA COLLECTION AND ANALYSIS

We conducted 1 individual telephone interview with each participant. After transcription, the data were analyzed and coded into common themes and categories. Triangulation of the data occurred via the use of multiple researchers and member checking to confirm the accuracy of the data.

RESULTS

Participants perceived the EBP Web-based modules to produce numerous outcomes regarding education and clinical practice. These outcomes included perceived knowledge gain among participants, an increase in the importance and scope of EBP, a positive effect on educators' didactic instruction patterns and on instilling value and practice of EBP among students, and an enhanced ability among clinicians to implement EBP within clinical practice. However, some clinicians reported the Web-based modules had no current effect on clinical practice.

CONCLUSIONS

Although the EBP Web-based modules were successful at enhancing knowledge among ATs, translation of knowledge into the classroom and clinical practice remains limited. Researchers should aim to identify effective strategies to help ATs implement EBP concepts into didactic education and clinical practice.

An evidence-based practice educational intervention for athletic trainers: a randomized controlled trial

CONTEXT

As evidence-based practice (EBP) becomes a necessity in athletic training, Web-based modules have been developed and made available to the National Athletic Trainers' Association membership as a mechanism to educate athletic trainers (ATs) on concepts of EBP.

OBJECTIVE

To assess the effect of an educational intervention on enhancing knowledge of EBP among ATs.

DESIGN

Randomized controlled trial.

SETTING

Web-based modules and knowledge assessment.

PATIENTS OR OTHER PARTICIPANTS

A total of 164 of 473 ATs (34.7% response rate), including professional athletic training students, graduate students, clinical preceptors, educators, and clinicians, were randomized into a control group (40 men, 42 women) or experimental group (33 men, 49 women).

INTERVENTION(S)

Ten Web-based modules were developed that covered concepts involved in the EBP process. Both groups completed the Evidence-Based Practice Knowledge Assessment before and after the intervention phase. During the intervention phase, the experimental group had access to the Web-based modules for 4 weeks, whereas the control group had no direct responsibilities for the investigation. The knowledge assessment consisted of 60 multiple choice questions pertaining to concepts presented in the 10 modules. Test-retest reliability was determined to be good (intraclass correlation coefficient [2,1] = 0.726, 95% confidence interval = 0.605, 0.814).

MAIN OUTCOME MEASURE(S)

Independent variables consisted of group (control, experimental) and time (preassessment, postassessment). Knowledge scores were tabulated by awarding 1 point for each correct answer (maximum = 60). Between-group and within-group differences were calculated using a 2 × 2 repeated-measures analysis of variance (P ≤ .05), post hoc t tests, and Hedges g effect size with 95% confidence intervals.

RESULTS

We found a group × time interaction (F₁,₁₆₂ = 26.29, P < .001). No differences were identified between the control (30.12 ± 5.73) and experimental (30.65 ± 5.93) groups during the preassessment (t₁₆₂ = 0.58, P = .84). The experimental group (36.35 ± 8.58) obtained higher scores on the postassessment than the control group (30.99 ± 6.33; t162 = 4.55, P = .01). No differences were identified among time instances within the control group (t₈₁ = 1.77, P = .08); however, the experimental group obtained higher scores on the postassessment than the preassessment (t₈₁ = 7.07, P < .001).

CONCLUSIONS

An educational intervention consisting of 10 Web-based modules was an effective mechanism to increase knowledge of foundational EBP concepts among ATs. However, it is not known whether ATs are integrating EBP into daily clinical practice. Researchers should determine whether increased knowledge of EBP affects the daily clinical decision making of ATs.

The assessment of a structured online formative assessment program: a randomised controlled trial

BACKGROUND

Online formative assessment continues to be an important area of research and methods which actively engage the learner and provide useful learning outcomes are of particular interest. This study reports on the outcomes of a two year study of medical students using formative assessment tools.

METHOD

The study was conducted over two consecutive years using two different strategies for engaging students. The Year 1 strategy involved voluntary use of the formative assessment tool by 129 students. In Year 2, a second cohort of 130 students was encouraged to complete the formative assessment by incorporating summative assessment elements into it. Outcomes from pre and post testing students around the formative assessment intervention were used as measures of learning. To compare improvement scores between the two years a two-way Analysis of Variance (ANOVA) model was fitted to the data.

RESULTS

The ANOVA model showed that there was a significant difference in improvement scores between students in the two years (mean improvement percentage 19% vs. 38.5%, p < 0.0001). Students were more likely to complete formative assessment items if they had a summative component. In Year 2, the time spent using the formative assessment tool had no impact on student improvement, nor did the number of assessment items completed.

CONCLUSION

The online medium is a valuable learning resource, capable of providing timely formative feedback and stimulating student-centered learning. However the production of quality content is a time-consuming task and careful consideration must be given to the strategies employed to ensure its efficacy. Course designers should consider the potential positive impact summative components to formative assessment may have on student engagement and outcomes.

Genomic education resources for nursing faculty

PURPOSE

The increasing recognition regarding the relevance of genomics across the scope of nursing healthcare practice has resulted in the drive to integrate appropriate genomic knowledge and skills into nurse education and training. In this final article of the series Genetics-Genomics and Nursing Education, we will look at genetic and genomic education resources and the factors that influence both their creation and use.

ORGANIZING CONSTRUCT

In considering nurse education from faculty and student perspectives, four identified areas of need have been used as the organizing constructs: guidance (what should be taught and at what level of complexity); support and training; access to genetics professionals and service users; and quality resources. This paper sets out to address the following points: (a) why there is a need for quality genomics education resources to support nurse education; (b) what is required from a resource to make it "useful" for the user; and (c) how the quality and impact of a resource can be measured. While not exhaustive, information is provided to a number of globally accessible resources, along with detailed descriptions of selected teaching or learning tools. Strategies for evaluating the suitability of a resource and suggestions on how genomic resources can be used within nurse education are provided.

CONCLUSIONS

The use of clinically relevant resources that link theory to professional practice and which meet predefined learning outcomes and practice indicators for nurse education and training will facilitate the integration of genomics into curricula by nurse faculty.

CLINICAL RELEVANCE

Providing clinically meaningful education and training in genomics is central to enabling every nurse to develop the appropriate knowledge and skills in genomics in order to provide optimum care to individuals and families now, and to facilitate the integration of new information and technology as it becomes available across mainstream healthcare services.

Technology-assisted education in graduate medical education: a review of the literature

Studies on computer-aided instruction and web-based learning have left many questions unanswered about the most effective use of technology-assisted education in graduate medical education.

Comparison of traditional methods with 3D computer models in the instruction of hepatobiliary anatomy

This study was designed to determine whether an interactive three-dimensional presentation depicting liver and biliary anatomy is more effective for teaching medical students than a traditional textbook format presentation of the same material. Forty-six medical students volunteered for participation in this study. Baseline demographic information, spatial ability, and knowledge of relevant anatomy were measured. Participants were randomized into two groups and presented with a computer-based interactive learning module comprised of animations and still images to highlight various anatomical structures (3D group), or a computer-based text document containing the same images and text without animation or interactive features (2D group). Following each teaching module, students completed a satisfaction survey and nine-item anatomic knowledge post-test. The 3D group scored higher on the post-test than the 2D group, with a mean score of 74% and 64%, respectively; however, when baseline differences in pretest scores were accounted for, this difference was not statistically significant (P = 0.33). Spatial ability did not statistically significantly correlate with post-test scores for the 3D group or the 2D group. In the post-test satisfaction survey the 3D group expressed a statistically significantly higher overall satisfaction rating compared to students in the 2D control group (4.5 versus 3.7 out of 5, P = 0.02). While the interactive 3D multimedia module received higher satisfaction ratings from students, it neither enhanced nor inhibited learning of complex hepatobiliary anatomy compared to an informationally equivalent traditional textbook style approach. .

Self-assessed learning style correlates to use of supplemental learning materials in an online course management system

BACKGROUND

The benefit of online learning materials in medical education is not well defined.

AIM

The study correlated certain self-identified learning styles with the use of self-selected online learning materials.

METHODS

First-year osteopathic medical students were given access to review and/or summary materials via an online course management system (CMS) while enrolled in a pre-clinical course. At the end of the course, students completed a self-assessment of learning style based on the Index of Learning Styles and a brief survey regarding their usage and perceived advantage of the online learning materials.

RESULTS

Students who accessed the online materials earned equivalent grades to those who did not. However, the study found that students who described their learning styles as active, intuitive, global, and/or visual were more likely to use online educational resources than those who identified their learning style as reflective, sensing, sequential, and/or verbal.

CONCLUSIONS

Identification of a student's learning style can help medical educators direct students to learning resources that best suit their individual needs.

Women's Health Curriculum for Internal Medicine Residents: Development, Implementation, and Evaluation

OBJECTIVE

Women's health knowledge and skills are important for physicians, but training is often inadequate. The objective of this project was to develop, implement, and evaluate a women's health curriculum for an internal medicine residency program.

METHODS

After assessing institutional factors, we developed a curriculum for a multidisciplinary clinical rotation with a web-based tutorial. We recruited faculty from several specialties relevant to the care of women to precept for the rotation and/or to provide teaching materials for the tutorial.

RESULTS

The curriculum for the 1-month rotation covered most of the recommended women's health topics. Internal medicine residents worked in a variety of clinical settings and were assigned to a web-based tutorial and a pretest and posttest. A statistically significant increase was seen in participants' mean posttest (71.7%) versus pretest (61.1%) scores (difference, 10.7%; 95% confidence interval [CI]: 4.7-16.6; P  =  .0009). No difference was seen in controls' mean posttest (56.5%) versus pretest (57.2%) scores (difference, -0.7%; 95% CI: -12.1-10.7; P  =  .9). Mean rotation evaluation responses ranged from 7.09 to 7.45 on a 9-point scale. The majority (93%) of survey respondents agreed that the rotation increased their skills in caring for women, and all agreed the program was well organized and that it increased their awareness of women's health issues.

CONCLUSION

A women's health curriculum using a web-based tutorial with a multidisciplinary clinical rotation can be successfully implemented in an internal medicine residency. The curriculum satisfied women's health training requirements, was associated with improvements in learning outcomes, and may be a model for women's health education.

Significant increase in factual knowledge with web-assisted problem-based learning as part of an undergraduate cardio-respiratory curriculum

In recent years, increasing attention has been paid to web-based learning although the advantages of computer-aided instruction over traditional teaching formats still need to be confirmed. This study examined whether participation in an online module on the differential diagnosis of dyspnoea impacts on student performance in a multiple choice examination of factual knowledge in cardiology and pneumology. A virtual problem-based learning environment for medical students supervised by postgraduate teachers was created. Seventy-four out of 183 fourth-year medical students volunteered to use the online module while attending a 6-week cardio-respiratory curriculum in summer 2007. Of these, 40 were randomly selected to be included (intervention group); the remaining 34 served as an internal control group. Analysis of all written exams taken during the preceding term showed that both groups were comparable (86.4 ± 1.1 vs. 85.9 ± 1.1%; p = 0.751). Students in the intervention group scored significantly higher in the final course assessment than students allocated to the control group (84.8 ± 1.3 vs. 79.5 ± 1.4%; p = 0.006; effect size 0.67). Thus, additional problem-based learning with an online module as part of an undergraduate cardio-respiratory curriculum lead to higher students' scores in an exam testing factual knowledge. Whether using this teaching format increases overall student motivation to engage in the learning process needs to be further investigated.

Creating interactive learning objects with PowerPoint: primer for lecture on the autonomic nervous system

BACKGROUND

In medical curricula, difficult topics are often presented to students with varied backgrounds and therefore at different levels of preparation to learn and assimilate the information.

AIM

A method is described to create an interactive primer for the study of a basic neuroscience topic to improve student preparation for and understanding of the autonomic nervous system.

METHODS

Action buttons or links within a PowerPoint show were used to create an interactive show. Branch points were imposed, as students answered questions correctly or incorrectly. In this way, the learning path was individualized depending on the level of comprehension.

RESULTS

Response to the interactive learning objects has been favorably received by the students with very favorable scores on the end-of-course evaluation. Preliminary analysis of the benefit of the interactive primer on summative examination suggests modest improvement on more difficult questions.

CONCLUSIONS

Use of the primer on the autonomic nervous system is discussed in the context of reports on the effectiveness of other blended learning and interactive learning experiences. The interactive tool described requires little facility with or support for web-based programming by faculty, and can be streamlined by creation of a PowerPoint template with pre-set interaction buttons.

Web-based collaborative training of clinical reasoning: a randomized trial

BACKGROUND

Clinical reasoning skills are essential for medical practice. Problem-based collaborative learning via the internet might prove useful in imparting these skills.

AIM

This randomized study assessed whether web-based learning (WBL) is superior to face-to-face problem-based learning (PBL) in the setting of a 6-week cardio-respiratory course.

METHODS

During winter term 2007/08, all 148 fourth-year medical students enrolled in the 6-week course consented to be randomized in small groups to diagnose a patient complaining of dyspnoea either using a virtual collaborative online module or a traditional PBL session. Clinical reasoning skills were assessed by means of a key feature examination at the end of the course.

RESULTS

No significant difference between the mean scores of both study groups was detected (p = 0.843). In virtual learning groups, costs for diagnostic tests were significantly correlated to the number of contributions to online group discussions (r = 0.881; p = 0.002). Evaluation data favored traditional PBL sessions over virtual collaborative learning.

CONCLUSION

While virtual collaborative learning was as effective as traditional PBL regarding the acquisition of clinical reasoning skills, it was less well accepted than traditional PBL. Future research needs to determine the ideal format and time-point for computer-assisted learning in medical education.

Interactive Internet-based cases for undergraduate otolaryngology education

Objectives: To determine the feasibility and effectiveness of virtual-patient computer-assisted instruction (CAI) in pre-clerkship undergraduate otolaryngology education.

Study Design: Prospective, randomized, controlled trial.

Subjects and Methods: Second-year medical students at the University of Western Ontario, Canada, were randomized into two groups: group A was given a CAI module and group B was presented with two Internet review articles, both covered specific learning objectives for pediatric stridor. Students completed randomized pre- and post-tests and a questionnaire one week later.

Results: Fifty-five students completed the study with 28 in group A and 27 in group B. Mean pretest scores were 59.1% in group A and 59.8% in group B (95% CI = −7.9% to 10.4%). Mean post-test scores were significantly elevated in group A (84.6%, P < 0.001) and group B (74.3%, P = 0.008). Group A had a significantly higher ( P = 0.02) mean post-test score than group B (mean difference of 10.2%). Students spent significantly more time ( P < 0.001) reading text articles (25.5 minutes) than completing the CAI (9.06 minutes). Forty-one (66%) students completed the survey. Thirty-six (88%) respondents indicated that they preferred CAI to online articles.

Conclusion: CAI is a feasible, effective, and efficient means of enhancing self-directed learning as supplementation to the pre-clerkship undergraduate otolaryngology curriculum.

Additional training with an obstetric simulator improves medical student comfort with basic procedures

OBJECTIVE

To determine if an obstetric birthing simulator can improve medical student understanding of and comfort with basic obstetric procedures.

STUDY DESIGN

Medical students were surveyed at the end of their obstetrics rotation regarding their knowledge and comfort with basic obstetric procedures. A group of students was trained on basic procedures utilizing an obstetric simulator. Survey results were compiled and analyzed with the Mann-Whitney U test.

RESULTS

In all, 60 untrained students and 18 simulator trained students completed surveys. Trained students were significantly more comfortable with fundal height measurements (P = 0.003), Leopold maneuvers (P < 0.001), fetal scalp electrode placement (P < 0.001), intrauterine pressure catheter placement (P < 0.001), and artificial rupture of membranes (P = 0.001) and reported better understanding of the indications for placement of a fetal scalp electrode (P = 0.01) and intrauterine pressure catheter (P = 0.03).

CONCLUSIONS

Additional training with an obstetric simulator improved medical student self-reported comfort with and understanding of basic procedures compared with standard resident and staff-directed instruction.

Satisfaction with web-based training in an integrated healthcare delivery network: do age, education, computer skills and attitudes matter?

BACKGROUND

Healthcare institutions spend enormous time and effort to train their workforce. Web-based training can potentially streamline this process. However the deployment of web-based training in a large-scale setting with a diverse healthcare workforce has not been evaluated. The aim of this study was to evaluate the satisfaction of healthcare professionals with web-based training and to determine the predictors of such satisfaction including age, education status and computer proficiency.

METHODS

Observational, cross-sectional survey of healthcare professionals from six hospital systems in an integrated delivery network. We measured overall satisfaction to web-based training and response to survey items measuring Website Usability, Course Usefulness, Instructional Design Effectiveness, Computer Proficiency and Self-learning Attitude.

RESULTS

A total of 17,891 healthcare professionals completed the web-based training on HIPAA Privacy Rule; and of these, 13,537 completed the survey (response rate 75.6%). Overall course satisfaction was good (median, 4; scale, 1 to 5) with more than 75% of the respondents satisfied with the training (rating 4 or 5) and 65% preferring web-based training over traditional instructor-led training (rating 4 or 5). Multivariable ordinal regression revealed 3 key predictors of satisfaction with web-based training: Instructional Design Effectiveness, Website Usability and Course Usefulness. Demographic predictors such as gender, age and education did not have an effect on satisfaction.

CONCLUSION

The study shows that web-based training when tailored to learners' background, is perceived as a satisfactory mode of learning by an interdisciplinary group of healthcare professionals, irrespective of age, education level or prior computer experience. Future studies should aim to measure the long-term outcomes of web-based training.

Working with patients with alcohol problems: a controlled trial of the impact of a rich media web module on medical student performance

INTRODUCTION/AIMS

We designed an interactive web module to improve medical student competence in screening and interventions for hazardous drinking. We assessed its impact on performance with a standardized patient (SP) vs. traditional lecture.

SETTING

First year medical school curriculum.

PROGRAM DESCRIPTION

The web module included pre/posttests, Flash(c), and text didactics. It centered on videos of two alcohol cases, each contrasting a novice with an experienced physician interviewer. The learner free-text critiqued each clip then reviewed expert analysis.

PROGRAM EVALUATION

First year medical students conveniently assigned to voluntarily complete a web module (N = 82) or lecture (N = 81) were rated by a SP in a later alcohol case. Participation trended higher (82% vs. 72%, p < .07) among web students, with an additional 4 lecture-assigned students crossing to the web module. The web group had higher mean scores on scales of individual components of brief intervention (assessment and decisional balance) and a brief intervention composite score (1-13 pt.; 9 vs. 7.8, p < .02) and self-reported as better prepared for the SP case.

CONCLUSIONS

A web module for alcohol use interview skills reached a greater proportion of voluntary learners and was associated with equivalent overall performance scores and higher brief intervention skills scores on a standardized patient encounter.

Limitations of student-driven formative assessment in a clinical clerkship. A randomised controlled trial

BACKGROUND

Teachers strive to motivate their students to be self-directed learners. One of the methods used is to provide online formative assessment material. The concept of formative assessment and use of these processes is heavily promoted, despite limited evidence as to their efficacy.

METHODS

Fourth year medical students, in their first year of clinical work were divided into four groups. In addition to the usual clinical material, three of the groups were provided with some form of supplementary learning material. For two groups, this was provided as online formative assessment. The amount of time students spent on the supplementary material was measured, their opinion on learning methods was surveyed, and their performance in summative exams at the end of their surgical attachments was measured.

RESULTS

The performance of students was independent of any educational intervention imposed by this study. Despite its ready availability and promotion, student use of the online formative tools was poor.

CONCLUSION

Formative learning is an ideal not necessarily embraced by students. If formative assessment is to work students need to be encouraged to participate, probably by implementing some form of summative assessment.

Personal digital assistant-enabled report content knowledgebase results in more complete pathology reports and enhances resident learning

We developed a personal digital assistant-based knowledgebase of surgical pathology report content recommendations and performed an experimental trial to test if the knowledgebase improved report completeness. The 15 experimental group and 13 control group residents were given microscope slides and corresponding reports with the final diagnosis section blanked-out, and were asked to complete the final diagnosis section during 3 study episodes (T0, T1, and T2). At T0 (baseline), experimental group and control group produced reports of comparable completeness. During T1, experimental group was allowed to use the knowledgebase while completing reports. During T1, experimental group produced more complete reports and were better judges of report completeness than control group. At T2, when neither group used the knowledgebase, experimental group's performance was still statistically better than control group's. Use of the knowledgebase did not ensure report completeness, but was associated with more complete reports and more accurate judgments of report completeness, and this performance advantage persisted in the absence of the knowledgebase.

Trends in study methods used in undergraduate medical education research, 1969-2007

CONTEXT

Evidence-based medical education requires rigorous studies appraising educational efficacy.

OBJECTIVES

To assess trends over time in methods used to evaluate undergraduate medical education interventions and to identify whether participation of medical education departments or centers is associated with more rigorous methods.

DATA SOURCES

The PubMed, Cochrane Controlled Trials Registry, Campbell Collaboration, and ERIC databases (January 1966-March 2007) were searched using terms equivalent to students, medical and education, medical crossed with all relevant study designs.

STUDY SELECTION

We selected publications in all languages from every fifth year, plus the most recent 12 months, that evaluated an educational intervention for undergraduate medical students. Four hundred seventy-two publications met criteria for review.

DATA EXTRACTION

Data were abstracted on number of participants; types of comparison groups; whether outcomes assessed were objective, subjective, and/or validated; timing of outcome assessments; funding; and participation of medical education departments and centers. Ten percent of publications were independently abstracted by 2 authors to assess validity of the data abstraction.

RESULTS

The annual number of publications increased over time from 1 (1969-1970) to 147 (2006-2007). In the most recent year, there was a mean of 145 medical student participants; 9 (6%) recruited participants from multiple institutions; 80 (54%) used comparison groups; 37 (25%) used randomized control groups; 91 (62%) had objective outcomes; 23 (16%) had validated outcomes; 35 (24%) assessed an outcome more than 1 month later; 21 (14%) estimated statistical power; and 66 (45%) reported funding. In 2006-2007, medical education department or center participation, reported in 46 (31%) of the recent publications, was associated only with enrolling more medical student participants (P = .04); for all studies from 1969 to 2007, it was associated only with measuring an objective outcome (P = .048). Between 1969 and 2007, the percentage of publications reporting statistical power and funding increased; percentages did not change for other study features.

CONCLUSIONS

The annual number of published studies of undergraduate medical education interventions demonstrating methodological rigor has been increasing. However, considerable opportunities for improvement remain.

Computer-assisted instruction for novice nurses in critical care

The current worldwide nursing shortage is having the greatest effect on the critical care areas as novice nurses enter these specialty areas in unprecedented numbers. Massive healthcare restructuring, a rapidly aging nursing work force, and high nursing turnover and absenteeism rates have all contributed to a healthcare environment that is struggling to care for critically ill patients. Computer-assisted instruction in the form of interactive computer programs may be used as an adjunct educational resource for these novice practitioners. These programs have the potential to bridge the gap between theory and practice, which may assist the novice nurse in achieving safe, competent clinical practice.

Linear versus web-style layout of computer tutorials for medical student learning of radiograph interpretation

RATIONALE AND OBJECTIVE

We sought to determine which is more effective in increasing skill in radiograph interpretation: a linear (PowerPoint-style) computer tutorial that locks the student into a fixed path through the material or a branched (Web-style) version that allows random access.

MATERIALS AND METHODS

We prepared a computer tutorial for learning how to interpret cervical spine radiographs. The tutorial has 66 screens including radiographs or graphics on almost every page and five unknown radiographs for the student to interpret. One version (linear) presents the material in a linear sequence with the unknown radiographs heading up "chapters" detailing an important aspect of the task. In the second (branched) version, the same 66 screens were accessed through hyperlinks in a frame beside the unknown radiographs. One hundred thirty-nine medical students at two sites participated in a randomized single-blinded controlled experiment. They interpreted cervical spine images as a pretest and then completed one of the two tutorial versions. Afterward, they did the same examination as a post-test.

RESULTS

The tutorial was successful, in both layouts, in improving the subjects' ability to interpret cervical spine radiograph images (effect size 2.1; 95% confidence interval 1.7-2.5). However, the layout did not make a difference to their gain in ability. Students in the linear group completed the tutorial in 17% less time (P < .001) but were slightly less likely to rate the tutorial as "valuable."

CONCLUSION

For these novice learners, computer tutorial layout does not affect knowledge gain. Students may be more satisfied with the linear layout, but in time-pressured situations, the Web-style layout may be preferable because it is more efficient.

Embedding medical student computer tutorials into a busy emergency department

OBJECTIVES

To explore medical students' use of computer tutorials embedded in a busy clinical setting; to demonstrate that such tutorials can increase knowledge gain over and above that attributable to the clinical rotation itself.

METHODS

Six tutorials were installed on a computer placed in a central area in an emergency department. Each tutorial was made up of between 33 and 85 screens of information that include text, graphics, animations, and questions. They were designed to be brief (10 minutes), focused, interactive, and immediately relevant. The authors evaluated the intervention using quantitative research methods, including usage tracking, surveys of faculty and students, and a randomized pretest-posttest study.

RESULTS

Over 46 weeks, 95 medical students used the tutorials 544 times, for an overall average of 1.7 times a day. The median time spent on completed tutorials was 11 minutes (average [SD], 14 [+/-12] minutes). Seventy-four students completed the randomized study. They completed 65% of the assigned tutorials, resulting in improved examination scores compared with the control (effect size, 0.39; 95% confidence interval = 0.15 to 0.62). Students were positively disposed to the tutorials, ranking them as "valuable." Fifty-four percent preferred the tutorials to small group teaching sessions with a preceptor. The faculty was also positive about the tutorials, although they did not appear to integrate the tutorials directly into their teaching.

CONCLUSIONS

Medical students on rotation in a busy clinical setting can and will use appropriately presented computer tutorials. The tutorials are effective in raising examination scores.

Teaching and assessing competence in cataract surgery

PURPOSE OF REVIEW

To review recent literature regarding innovative techniques, methods of teaching and assessing competence and skill in cataract surgery.

RECENT FINDINGS

The need for assessment of surgical competency and the requirement of wet lab facilities in ophthalmic training programs are being increasingly emphasized. Authors have proposed the use of standardized forms to collect objective and subjective data regarding the residents' surgical performance. Investigators have reported methods to improve visualization of cadaver and animal eyes for the wet lab, including the use of capsular dyes. The discussion of virtual reality as a teaching tool for surgical programs continues. Studies have proven that residents trained on a laparoscopic simulator outperformed nontrained residents during actual surgery for both surgical times and numbers of errors. Besides virtual reality systems, a program is being developed to separate the cognitive portion from the physical aspects of surgery. Another program couples surgical videos with three-dimensional animation to enhance the trainees' topographical understanding.

SUMMARY

Proper assessment of surgical competency is becoming an important focus of training programs. The use of surgical data forms may assist in standardizing objective assessments. Virtual reality, cognitive curriculum and animation video programs can be helpful in improving residents' surgical performance.

Computer-Based Learning in Medical Education: A Critical View

A number of reports in the past decade have concluded that the medical education system must be reformed. These reports often call for the incorporation of new technologies into the educational process. One technology that has found its way into the medical educational environment is the personal computer. This essay critically examines the introduction of the personal computer into medical education, focusing on computer-based learning (CBL). The author concludes that evidence demonstrating the effectiveness of CBL is weak, and evidence supporting the notion that CBL enhances learning (compared with traditional methods) is weaker still. The author also argues that the decision to use CBL in the place of face-to-face traditional instruction has important negative implications for participants in medical education and may undermine the important role of patients in the education of doctors.

Virtual Reality in Ophthalmology Training

Current training models are limited by an unstructured curriculum, financial costs, human costs, and time constraints. With the newly mandated resident surgical competency, training programs are struggling to find viable methods of assessing and documenting the surgical skills of trainees. Virtual-reality technologies have been used for decades in flight simulation to train and assess competency, and there has been a recent push in surgical specialties to incorporate virtual-reality simulation into residency programs. These efforts have culminated in an FDA-approved carotid stenting simulator. What role virtual reality will play in the evolution of ophthalmology surgical curriculum is uncertain. The current apprentice system has served the art of surgery for over 100 years, and we foresee virtual reality working synergistically with our current curriculum modalities to streamline and enhance the resident's learning experience.