Self-learning digital modules in dermatology: a pilot study

An Online Dermatology Teaching Module for Undergraduate Medical Students amidst the COVID-19 Pandemic: An Experience and Suggestions for the Future

INTRODUCTION

The COVID-19 pandemic has disrupted clinical teaching in medical schools. Direct patient interaction, especially in groups, in out-patient departments or wards, was also made difficult. Institutes have adapted to the changed circumstances by increasing the use of online learning. We share our experience with a module of online Dermatology for undergraduate students.

METHODS

An online module, aligned with the existing course objectives was designed and applied for two cohorts (year 4 and year 5). The module included student manuals, Powerpoint- presentations, videos, and quizzes uploaded on dedicated online management systems. There were live interactive sessions in small groups also. The small group session included student-led case presentations and faculty-led simulated case discussions. Feedback was taken from both the students and the faculty regarding the module using a structured questionnaire.

RESULTS

A total of 45 students and 4 faculty responded to the respective questionnaires. A majority of the students felt that the module covered the planned content adequately. The faculty and the majority of the students were also satisfied with the technical aspects of the module. Student and faculty concerns were mainly in the area of assessment and practical skills. While faculty were concerned about the validity of the assessment, students were concerned mainly about difficulty and the need for more orientation regarding the assessment.

CONCLUSIONS

The students and faculty were satisfied with the online Dermatology module in our study. However, the validity of assessment and the training of practical skills are major limitations.

Evaluation of e-learning for medical education in low- and middle-income countries: A systematic review

In low- and middle-income countries (LMICs), e-learning for medical education may alleviate the burden of severe health worker shortages and deliver affordable access to high quality medical education. However, diverse challenges in infrastructure and adoption are encountered when implementing e-learning within medical education in particular. Understanding what constitutes successful e-learning is an important first step for determining its effectiveness. The objective of this study was to systematically review e-learning interventions for medical education in LMICs, focusing on their evaluation and assessment methods. Nine databases were searched for publications from January 2007 to June 2017. We included 52 studies with a total of 12,294 participants. Most e-learning interventions were pilot studies (73%), which mainly employed summative assessments of study participants (83%) and evaluated the e-learning intervention with questionnaires (45%). Study designs, evaluation and assessment methods showed considerable variation, as did the study quality, evaluation periods, outcome and effectiveness measures. Included studies mainly utilized subjective measures and custom-built evaluation frameworks, which resulted in both low comparability and poor validity. The majority of studies self-concluded that they had had an effective e-learning intervention, thus indicating potential benefits of e-learning for LMICs. However, MERSQI and NOS ratings revealed the low quality of the studies' evidence for comparability, evaluation instrument validity, study outcomes and participant blinding. Many e-learning interventions were small-scale and conducted as short-termed pilots. More rigorous evaluation methods for e-learning implementations in LMICs are needed to understand the strengths and shortcomings of e-learning for medical education in low-resource contexts. Valid and reliable evaluations are the foundation to guide and improve e-learning interventions, increase their sustainability, alleviate shortages in health care workers and improve the quality of medical care in LMICs.

The Effect of Self-learning Module on Nursing Students' Clinical Competency: A Pilot Study

BACKGROUND

Self-learning module (SLM) is designed for independent learning. In this study, the hypothesis that SLM is effective to some extent in improving clinical competence in nursing students was tested.

MATERIALS AND METHODS

The study employed a randomized controlled design. In this study, 46 nursing students were randomized into the control or intervention group. Study tools included a demographic information form and nursing skills checklist. Unlike the control group, the intervention group received clinical SLM. Nursing students' clinical competency was measured at the end of the intervention through objective structured clinical examination. Statistical analysis was performed in SPSS software. A p value < 0.050 was considered statistically significant.

RESULTS

In total, 46 students participated in this study. The Mean (SD) age of the study participants was 18.80 (1.06) years. There was a significant difference in students' clinical competency between the control and intervention groups (Mann-Whitney U-test: p = 0.010). Mean (SD) of clinical competency in the control and SLM groups was 58.19 (6.41) and 62.83 (6.05), respectively. Results of the group equivalency test indicated that all demographic variables were equivalent between the groups. Moreover, there was no significant difference between women and men in terms of clinical competency.

CONCLUSIONS

According to the results, the use of SLM could help the students enhance the quality of nursing clinical competency.

How Self-Directed e-Learning Contributes to Training for Medical Licentiate Practitioners in Zambia: Evaluation of the Pilot Phase of a Mixed-Methods Study

BACKGROUND

Zambia faces a severe shortage of health workers, particularly in rural areas. To tackle this shortage, the Medical Licentiate program was initiated at Chainama College of Health Sciences in the capital, Lusaka, in 2002. The objective of the program was to alleviate the shortage of human resources in curative care. On-the-job training is conducted in decentralized teaching hospitals throughout Zambia. However, the program faces significant challenges such as shortages of senior medical instructors and learning materials.

OBJECTIVE

Our aim was to address these challenges by introducing a self-directed, e-learning platform with an offline tablet as part of a collaborative blended-learning intervention to supplement local teaching and training.

METHODS

The pilot phase of the e-learning platform was evaluated using a mixed-methods approach with a convergent parallel design. Various methods were employed to test the data's adequacy and potential for generating valid results. Methods included questionnaires according to the technology acceptance model and information system success model by DeLone and McLean, semistructured interviews, learner diaries, pretesting, the collection of usage data, exam results, demographics, and informal feedback. Outcome measures included usage, adoption, efficiency, acceptance, user-friendliness, and gained knowledge and skills.

RESULTS

In total, 52 students and 17 medical instructors participated in the pilot evaluation. The questionnaire results showed a high acceptance of the technology (>80%) and high agreement (>75%) with the e-learning platform. Semistructured interview results showed an overall appreciation of the e-learning intervention, but the need for more e-learning materials. Respondents identified a need for multimedia materials that transfer skills such as medical procedure visualization and interactive exercises to practice procedural knowledge. The learning diaries identified the lack of specific learning materials and potential shortcomings of existing learning materials. However, students were satisfied with the current e-learning content. The majority of students used the e-learning platform offline on their tablets; online e-learning was underutilized.

CONCLUSIONS

The pilot phase of the tablet-based e-learning platform to support the self-directed learning intervention was well received and appreciated by students and medical instructors of Chainama College of Health Sciences. E-learning for knowledge acquisition appears to be adequate and feasible for this low-resource educational environment. Our evaluation results guide the further development of the full implementation of the e-learning platform in this educational setting. E-learning materials should reflect curriculum requirements, and additional multimedia and interactive content is needed, as well as improved integration and active participation from medical instructors in the e-learning processes.

The attitudes of primary healthcare providers towards web-based training on public health services in rural China: a cross-sectional study

OBJECTIVES

To explore the attitudes of primary healthcare workers, including township public health workers (TPHWs) and village doctors (ViDs), towards web-based training on basic public health services (BPHS) and to examine the factors influencing their attitudes.

STUDY DESIGN

Cross-sectional study.

METHODS

Questionnaires addressing training status, needs, and attitudes towards web-based public health training were administered to 2768 primary healthcare workers from May to September 2013. Multivariate logistic regression models were used to identify the factors that were significantly associated with a positive attitude towards web-based public health training.

RESULTS

Among the 2768 participants, 90.6% of the TPHWs and 86.9% of the ViDs expressed a positive attitude towards web-based BPHS training. TPHWs who had a positive attitude towards previous public health training (odds ratio [OR] = 2.75, 95% confidence interval [CI] = 1.28-5.93) and better computer skills (OR = 2.59, 95% CI = 1.03-6.48) were more likely to adopt web-based training on BPHS, as were ViDs who had better computer skills (OR = 2.54, 95% CI = 1.58-4.11) and better Internet speeds (neutral: OR = 2.81, 95% CI = 1.58-5.01; satisfied: OR = 2.53, 95% CI = 1.28-5.01). TPHWs who tended to read papers (OR = 0.24, 95% CI = 0.11-0.50) and were aged 50 years or older (OR = 0.34, 95% CI = 0.14-0.87), as were ViDs who tended to read papers (OR = 0.48, 95% CI = 0.29-0.77), expressed a more negative attitude towards web-based BPHS training.

CONCLUSIONS

The findings indicated that most primary healthcare workers have a positive attitude towards web-based BPHS training. More priority measures, such as conducting computer training, improving Internet quality and integrating mobile technology, are recommended and will further improve the implementation of web-based public health training programs.

Is "modular" the way to go for small group learning in community medicine in undergraduate clinical postings?

Context:

There is a need to shift from the didactic lecture-based instruction to more student-centered active learning methods for undergraduate teaching in community medicine.

Aims:

To compare didactic and modular method of learning on Level 1 and 2 on Kirkpatrick’s training evaluation model.

Settings and Design:

This was a two-arm educational intervention study for a small group of the 2^nd year MBBS students in their 4^th semester during clinical posting in the subject of community medicine.

Subjects and Methods:

The topic chosen was “rabies prophylaxis” in the 2^nd clinical posting during 4^th semester. With permission from Institutional Ethics Committee, first batch of 17 students was taught this topic by didactic method. Next batch of 22 students was taught by the modular method. A self-reading module was prepared for this study and validated by three teachers. What was different in modular teaching was a circular sitting arrangement, module reading by students, video presentation, and exercise using case vignettes.

Statistical Analysis Used:

Student’s t-test was used for pre- and post-test score comparison and Mann–Whitney U-test for students' responses on Likert scale.

Results:

The mean gain in obtained marks after modular learning (7.9/15) was significantly higher as compared to gain after didactic teaching (5.9/15) (P = 0.0038); more students asserted to be confident to manage a case in modular group compared to the didactic group (P < 0.05) indicating a higher level of learning through modular teaching.

Conclusions:

Modular teaching fares better than didactic method and hence should be used more frequently in community medicine clinical posting.

Role of Clinical Images Based Teaching as a Supplement to Conventional Clinical Teaching in Dermatology

Introduction:

Clinical Dermatology is a visually oriented specialty, where visually oriented teaching is more important than it is in any other specialty. It is essential that students must have repeated exposure to common dermatological disorders in the limited hours of Dermatology clinical teaching.

Aim:

This study was conducted to assess the effect of clinical images based teaching as a supplement to the patient based clinical teaching in Dermatology, among final year MBBS students.

Methods:

A clinical batch comprising of 19 students was chosen for the study. Apart from the routine clinical teaching sessions, clinical images based teaching was conducted. This teaching method was evaluated using a retrospective pre-post questionnaire. Students’ performance was assessed using Photo Quiz and an Objective Structured Clinical Examination (OSCE). Feedback about the addition of images based class was collected from students.

Results:

A significant improvement was observed in the self-assessment scores following images based teaching. Mean OSCE score was 6.26/10, and that of Photo Quiz was 13.6/20.

Conclusion:

This Images based Dermatology teaching has proven to be an excellent supplement to routine clinical cases based teaching.

Integrated modular teaching in dermatology for undergraduate students: A novel approach

CONTEXT

Undergraduate teaching in dermatology comprises didactic lectures and clinical classes. Integrated modular teaching is a novel approach, which integrates basic sciences with dermatology in the form of a module. Further the module also incorporates various teaching modalities, which facilitate active participation from students and promotes learning. The pre- and post-test values showed the effectiveness of the integrated module. The students feedback was encouraging.

AIMS

The aim of this study was to determine the acceptance and opinion of undergraduate students regarding integrated modular teaching as a new teaching aid in dermatology.

SETTINGS AND DESIGN

This was a descriptive study. Varied teaching methodologies involving multiple disciplines were undertaken in six major undergraduate topics in dermatology for seventh and eighth semester students.

MATERIALS AND METHODS

A total of six modules were conducted over a period of 12 months for students of seventh and eighth semesters. The topics for the various modules were sexually transmitted diseases, acquired immunodeficiency syndrome, oral ulcers, leprosy, connective tissue disorders and psoriasis. Faculty members from different disciplines participated. Pre- and post-test were conducted before and after the modules respectively to gauge the effectiveness of the modules.

RESULTS

It was found that almost every student had a better score on the posttest as compared to the pretest. General feedback obtained from the students showed that all of them felt that modular teaching was a more interesting and useful teaching learning experience than conventional teaching.

CONCLUSIONS

Integrated modular teaching can be an effective adjunct in imparting theoretical and practical knowledge to the students. Further, various teaching methodologies can be used in integrated modules effectively with active student participation. Thus integrated modular teaching addresses two important issues in medical education, namely integration and active student participation.

E-learning in medical education in resource constrained low- and middle-income countries

BACKGROUND

In the face of severe faculty shortages in resource-constrained countries, medical schools look to e-learning for improved access to medical education. This paper summarizes the literature on e-learning in low- and middle-income countries (LMIC), and presents the spectrum of tools and strategies used.

METHODS

Researchers reviewed literature using terms related to e-learning and pre-service education of health professionals in LMIC. Search terms were connected using the Boolean Operators "AND" and "OR" to capture all relevant article suggestions. Using standard decision criteria, reviewers narrowed the article suggestions to a final 124 relevant articles.

RESULTS

Of the relevant articles found, most referred to e-learning in Brazil (14 articles), India (14), Egypt (10) and South Africa (10). While e-learning has been used by a variety of health workers in LMICs, the majority (58%) reported on physician training, while 24% focused on nursing, pharmacy and dentistry training. Although reasons for investing in e-learning varied, expanded access to education was at the core of e-learning implementation which included providing supplementary tools to support faculty in their teaching, expanding the pool of faculty by connecting to partner and/or community teaching sites, and sharing of digital resources for use by students. E-learning in medical education takes many forms. Blended learning approaches were the most common methodology presented (49 articles) of which computer-assisted learning (CAL) comprised the majority (45 articles). Other approaches included simulations and the use of multimedia software (20 articles), web-based learning (14 articles), and eTutor/eMentor programs (3 articles). Of the 69 articles that evaluated the effectiveness of e-learning tools, 35 studies compared outcomes between e-learning and other approaches, while 34 studies qualitatively analyzed student and faculty attitudes toward e-learning modalities.

CONCLUSIONS

E-learning in medical education is a means to an end, rather than the end in itself. Utilizing e-learning can result in greater educational opportunities for students while simultaneously enhancing faculty effectiveness and efficiency. However, this potential of e-learning assumes a certain level of institutional readiness in human and infrastructural resources that is not always present in LMICs. Institutional readiness for e-learning adoption ensures the alignment of new tools to the educational and economic context.

Comparison of three problem-based learning conditions (real patients, digital and paper) with lecture-based learning in a dermatology course: a prospective randomized study from China

BACKGROUND

The precise effect and the quality of different cases used in dermatology problem-based learning (PBL) curricula are yet unclear.

AIM

To prospectively compare the impact of real patients, digital, paper PBL (PPBL) and traditional lecture-based learning (LBL) on academic results and student perceptions.

METHODS

A total of 120 students were randomly allocated into either real-patients PBL (RPBL) group studied via real-patient cases, digital PBL (DPBL) group studied via digital-form cases, PPBL group studied via paper-form cases, or conventional group who received didactic lectures. Academic results were assessed through review of written examination, objective structured clinical examination and student performance scores. A five-point Likert scale questionnaire was used to evaluate student perceptions.

RESULTS

Compared to those receiving lectures only, all PBL participants had better results for written examination, clinical examination and overall performance. Students in RPBL group exhibited better overall performance than those in the other two PBL groups. Real-patient cases were more effective in helping develop students' self-directed learning skills, improving their confidence in future patient encounters and encouraging them to learn more about the discussed condition, compared to digital and paper cases.

CONCLUSION

Both real patient and digital triggers are helpful in improving students' clinical problem-handling skills. However, real patients provide greater benefits to students.

Effectiveness of a modified tutorless problem-based learning method in dermatology - a pilot study

BACKGROUND AND AIMS

Problem-Based Learning (PBL) is a student-centred instructional strategy in which students learn in a collaborative manner, the learning process being guided by a facilitator. One of the limitations of conventional PBL in medical education is the need for adequate resources in terms of faculty and time. Our study aimed to compare conventional PBL in dermatology with a modified tutorless PBL in which pre-listed cues and the use of digital media help direct the learning process.

METHODS

Thirty-one-fifth year medical students were divided into two groups: the study group comprising 16 students were exposed to the modified PBL, whereas the control group comprising 15 students were given the same scenarios and triggers, but in a conventional tutor-facilitated PBL. Knowledge acquisition and student feedback were assessed using a post-test and a Likert scale-based questionnaire, respectively.

RESULTS

The post-test marks showed no significant statistical differences between the two groups. The general feedback regarding the modified PBL was positive and the students felt comfortable with the module. The learning objectives were met satisfactorily in both groups.

CONCLUSION

Modified tutorless PBL modules might be an effective method to incorporate student-centred learning in dermatology without constraints in terms of faculty resources or time.