Filling the gaps between theory and daily clinical procedural skills training in family medicine

Flexible e-learning video approach to improve fundus examination skills for medical students: a mixed-methods study

BACKGROUND

Training for the fundus examination using traditional teaching is challenging, resulting in low generalist physicians' confidence in performing the funduscopic examination. There is growing evidence suggesting a flexible e-learning video approach's value in teaching physical examination procedures. However, whether the flexible e-learning video approach is superior to the traditional, face-to-face (F2F) lecture-based teaching for the funduscopic exam and the cognitive processes supporting its effectiveness has not yet been determined.

METHODS

We conducted a sequential explanatory mixed-method study to compare the flexible e-learning video approach's effectiveness versus the F2F lecture-based approach for teaching the funduscopic exam to medical students at Chiba University in Japan. Medical students were randomly assigned to either a flexible e-learning video approach group or a F2F lecture approach group. We then quantitatively measured the diagnostic accuracy of funduscopic findings before and after attending the specific classrooms. Next, we conducted student focus groups to explore the students' thinking processes in the flexible e-learning video approach vs. the F2F lecture-based teaching of fundus examination. The qualitative data were analyzed using the qualitative content analysis method.

RESULTS

The mean diagnostic accuracy scores in the post-test significantly increased from pre-test in the intervention group (36.6 to 63.4%, p < 0.001). Post-post comparisons across the two groups revealed a significant difference (intervention group 63.4% vs. control group 34.6%, p < 0.001). Six semi-structured focused group interviews were conducted (n = 36). In the flexible e-learning video approach group, we identified ten categories corresponding to four levels of the revised Bloom's taxonomy: remember, understand, apply, analyze. Five categories were identified in the traditional F2F lecture approach group corresponding to three revised Bloom's taxonomy levels: understand, apply, analyze. Interrater reliability was substantial (Cohen's kappa = 0.81).

CONCLUSIONS

Teaching medical students funduscopic examination using the flexible e-learning video approach leads to improved diagnostic accuracy of funduscopic examinations. The flexible e-learning video teaching method enabled higher cognitive activity levels than the traditional, lecture-based classroom, as assessed using the revised Bloom's taxonomy.

TRIAL REGISTRATION

This study was registered with the University Hospital Medical Information Network Clinical Trials Registry on 08/02/2020 (Unique trial number: UMIN 000039434 ).

The Role of Video-Assisted E-Learning in Intrauterine Contraceptive Device Insertion Training

Introduction

Intrauterine contraceptive device (IUCD) insertion is an important procedural skill for primary care physicians. Procedural skill training can be challenging. E-learning has been rapidly employed in medical education. The purpose of this study was to evaluate the role of a video-assisted e-learning module in knowledge and skill transfer for IUCD insertion training.

Methods

We used a quasi-experimental, one-group, pre/posttest study design. Thirty-one primary care doctors (family medicine residents and new medial officers) at a primary care training center participated in the study. All participants assessed the e-learning module at the training center. We performed on-site pre/posttests of knowledge and procedural steps (posttest only). We obtained satisfaction with e-learning and perceived confidence level with an anonymous questionnaire survey.

Results

There was a significant increase in the knowledge test scores from a median interquartile range score of 12 (10-15) to 18 (17-19) post-e-learning (P<.01). All participants attained the minimum passing score of 15 of 20 (75%) post-e-learning. However, only 20 of 31 (64.5%) participants met the minimum passing standard for procedural step test post-e-learning. Ninety-three percent of the participants reported satisfaction with the e-learning course. The median score for confidence level in performing the procedure increased significantly after e-learning.

Conclusion

The e-learning module may be an effective way of delivering instructional content in procedural training. It provides time and location flexibility and is useful for pretraining. Psychomotor skills for clinical procedures, however, may be difficult to acquire by e-learning alone. It must be supplemented with deliberate practice and hands-on learning in simulation workshops.