How to design effective educational videos for teaching evidence-based medicine to undergraduate learners - systematic review with complementing qualitative research to develop a practicable guide

BACKGROUND

eLearning can be an effective tool to achieve learning objectives. It facilitates asynchronous distance learning, increasing flexibility for learners and instructors. In this context, the high educational value of videos provides an invaluable primary component for longitudinal digital curricula, especially for maintaining knowledge on otherwise rarely taught subjects. Although literature concerning eLearning evaluation exists, research comprehensively describing how to design effective educational videos is lacking. In particular, studies on the requirements and design goals of educational videos need to be complemented by qualitative research using grounded theory methodology.

METHODS

Due to the paucity of randomized controlled trials in this area, there is an urgent need to generate recommendations based on a broader fundament than a literature search alone. Thus, the authors have employed grounded theory as a guiding framework, augmented by Mayring's qualitative content analysis and commonly used standards. An adaptive approach was conducted based on a literature search and qualitative semi-structured interviews. Drawing on these results, the authors elaborated a guide for creating effective educational videos.

RESULTS

The authors identified 40 effective or presumedly effective factors fostering the success of video-based eLearning in teaching evidence-based medicine, providing a ready-to-use checklist. The information collected via the interviews supported and enriched much of the advice found in the literature.

DISCUSSION

To the authors' knowledge, this type of comprehensive guide for video-based eLearning needs has not previously been published. The interviews considerably contributed to the results. Due to the grounded theory-based approach, in particular, consensus was achieved without the presence of a formal expert panel. Although the guide was created with a focus on teaching evidence-based medicine, due to the general study selection process and research approach, the recommendations are applicable to a wide range of subjects in medical education where the teaching aim is to impart conceptual knowledge.

Asynchronous lecture participation negatively predicts exam scores for females and students of color in an introductory physiology course during COVID-19

In response to COVID-19, educators rapidly pivoted to new and innovative ways of delivering lecture material. The ability to host synchronous lectures on platforms like Zoom gave students continued access to classroom material in the face of an ongoing pandemic. The purpose of this study was to investigate the differences in exam scores between students attending a physiology class (PHSL3051) synchronously via Zoom or asynchronously by viewing recorded lectures posted after class. Students in PHSL3051 were evaluated with four unit exams and one cumulative final exam. Although pooled analysis of all students showed that synchronous lecture viewing positively predicted exam scores, this positive association was even larger when the data were analyzed by gender and ethnicity. For female-identified students and students of color (SOC), attending lectures synchronously was associated with average scores on every unit exam that were higher by 2.7-7.4 percentage points. Moreover, the greater a student's synchronous participation in the course throughout the semester, the better that student's performance on the cumulative final exam was likely to be. These data highlight the need to better understand how different groups of undergraduate students select and respond to different assessment methods used in the same course, which may have long-term effects on their overall performance at 4-year institutions.NEW & NOTEWORTHY This study examined the relationship between lecture attendance (synchronous or asynchronous) and exam scores throughout the semester. Although everyone in the course benefited from synchronous lecture attendance, our data indicated that students of color (SOC) and female-identified students benefited most. SOC and female-identified students who participated synchronously had even higher mean scores on all exams within the course compared with SOC and female-identified students who participated asynchronously by watching recordings of the same lectures.

An Asynchronous Evidence-Based Mindfulness Intervention for Professional Nurses

Purpose: To evaluate the impact of an abbreviated (4-week) and asynchronous, mindfulness-based intervention (MBI) on nurses' perceived stress and mindful attention and awareness. Design: An evidence-based quality improvement pilot program. Methods: The participants (n = 15 nurses) attended a 4-week, asynchronous MBI. The participants attended a 90-minute webinar on mindfulness as a prerequisite, followed by 4 weeks of guided meditation and informal mindfulness practice materials. The MBI was offered remotely with self-modulated practice. Participants also provided the number of days per week they participated in formal meditation practice. Project participants completed pre- and post-intervention questionnaires. Project instruments included the Mindful Attention Awareness Scale (MAAS) and the 10-item Perceived Stress Scale (PSS). Findings: 12 complete pre-and post-intervention surveys were analyzed. Significant improvements were noted in participant mean MAAS scores post-intervention (p = .004). Cumulative PSS scores also decreased post-intervention (p = .009). Conclusion: The 4-week MBI demonstrated a statistically significant impact on nurses' perceived stress and mindful attention and awareness. Additionally, this Doctor of Nursing Practice (DNP) student led program was offered in an asynchronous and remote format, which was received well by program participants and may be a practical option for future MBIs.

Implementation of Provider-Focused Education to Improve Laboratory Screening for Pediatric Patients With Elevated Body Mass Index in Primary Care: A Quality Improvement Project

INTRODUCTION

Children with elevated body mass index (BMI) do not consistently receive recommended laboratory screenings. This project aimed to increase provider screening rates and knowledge of screening guidelines for this population.

METHOD

This project utilized the Rosswurm and Larrabee evidence-based practice model. Providers completed education with pretest and posttest design. Laboratory screening rates were measured with retrospective chart reviews, and a project satisfaction survey was conducted.

RESULTS

Nine (82%) of 11 providers showed an increase in knowledge of screening for children with elevated BMI. Laboratory screening increased (27% to 39%) above the preintervention median (25%) for children with obesity and was above the median (22%) for one month of the project (15% to 26%) for children with overweight.

CONCLUSIONS

Project results suggest education improved knowledge and compliance with guidelines for laboratory screening of children with an elevated BMI. Asynchronous education and sharing of compliance rates are adaptable to similar quality improvement projects.

Teaching LGBTQ+ Health, a Web-Based Faculty Development Course: Program Evaluation Study Using the RE-AIM Framework

BACKGROUND

Many health professions faculty members lack training on fundamental lesbian, gay, bisexual, transgender, and queer (LGBTQ+) health topics. Faculty development is needed to address knowledge gaps, improve teaching, and prepare students to competently care for the growing LGBTQ+ population.

OBJECTIVE

We conducted a program evaluation of the massive open online course Teaching LGBTQ+ Health: A Faculty Development Course for Health Professions Educators from the Stanford School of Medicine. Our goal was to understand participant demographics, impact, and ongoing maintenance needs to inform decisions about updating the course.

METHODS

We evaluated the course for the period from March 27, 2021, to February 24, 2023, guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. We assessed impact using participation numbers, evidence of learning, and likelihood of practice change. Data included participant demographics, performance on a pre- and postcourse quiz, open-text entries throughout the course, continuing medical education (CME) credits awarded, and CME course evaluations. We analyzed demographics using descriptive statistics and pre- and postcourse quiz scores using a paired 2-tailed t test. We conducted a qualitative thematic analysis of open-text responses to prompts within the course and CME evaluation questions.

RESULTS

Results were reported using the 5 framework domains. Regarding Reach, 1782 learners participated in the course, and 1516 (85.07%) accessed it through a main course website. Of the different types of participants, most were physicians (423/1516, 27.9%) and from outside the sponsoring institution and target audience (1452/1516, 95.78%). Regarding Effectiveness, the median change in test scores for the 38.1% (679/1782) of participants who completed both the pre- and postcourse tests was 3 out of 10 points, or a 30% improvement (P<.001). Themes identified from CME evaluations included LGBTQ+ health as a distinct domain, inclusivity in practices, and teaching LGBTQ+ health strategies. A minority of participants (237/1782, 13.3%) earned CME credits. Regarding Adoption, themes identified among responses to prompts in the course included LGBTQ+ health concepts and instructional strategies. Most participants strongly agreed with numerous positive statements about the course content, presentation, and likelihood of practice change. Regarding Implementation, the course cost US $57,000 to build and was intramurally funded through grants and subsidies. The course faculty spent an estimated 600 hours on the project, and educational technologists spent another 712 hours. Regarding Maintenance, much of the course is evergreen, and ongoing oversight and quality assurance require minimal faculty time. New content will likely include modules on transgender health and gender-affirming care.

CONCLUSIONS

Teaching LGBTQ+ Health improved participants' knowledge of fundamental queer health topics. Overall participation has been modest to date. Most participants indicated an intention to change clinical or teaching practices. Maintenance costs are minimal. The web-based course will continue to be offered, and new content will likely be added.

Emergency Medicine Provider Impressions of Novel SMS-Based Toxicology Module

The diagnosis and treatment of common toxicologic disorders is an area of core content that emergency medicine (EM) resident physicians and physician assistants (PA) are required to demonstrate competence in order to become proficient practicing clinicians. Even when EM programs have a required toxicology elective, learners do not encounter all core toxicologic presentations. To supplement these knowledge gaps, many toxicology curriculums rely on internet learning modules which have variable uptake in practice. With remote learning and education becoming more common, we aim to perform a need-based assessment of EM resident and PA toxicology education and use the results to develop and deploy a text message-based, interactive toxicology supplemental program for EM residents and PAs and measure its acceptability and preliminary effectiveness to teach core toxicology principles.

The Impact of a Web-Based Preintubation Preparation Module on the Knowledge, Confidence, and Behavior of Critical Care Fellows: A Single-Center Pilot Study

OBJECTIVES

The objectives of this study were to standardize airway management among critical care fellows and to evaluate whether the completion of a web-based preintubation airway preparation module improves their knowledge and behaviors in the identification and preparation of difficult airways.

METHODS

Critical care experts used international guidelines to develop the module, which contained mandatory readings, brief lectures, and a case-based activity. We measured learner satisfaction, improvements in fellows' preintubation preparation knowledge, and safety-oriented behavior. The paired t-test was used to compare knowledge assessment scores and the chi-square test was used to compare the categorical variables in the evaluation of the behavior construct.

RESULTS

All trainees (N = 14) completed the module and were satisfied with its contents and structure. Fellows logged 114 intubations during the study period. The mean score on the knowledge test increased (pre 79% vs post 90%, P = .02) postmodule and there was a significant increase in documentation of airway risk stratification in fellows' procedure notes (65.9% vs 72.9%, P = .049). All respondents were confident that they would be able to apply what they learned in the module into clinical practice and that their patients would likely benefit from their new knowledge.

CONCLUSION

The implementation of an asynchronous web-based module on airway assessment and intubation preparation was feasible. The module was engaging, enhanced the knowledge of our trainees, and improved procedural documentation.

Developing and Integrating Asynchronous Web-Based Cases for Discussing and Learning Clinical Reasoning: Repeated Cross-sectional Study

BACKGROUND

Trainees rely on clinical experience to learn clinical reasoning in pediatric emergency medicine (PEM). Outside of clinical experience, graduate medical education provides a handful of explicit activities focused on developing skills in clinical reasoning.

OBJECTIVE

In this paper, we describe the development, use, and changing perceptions of a web-based asynchronous tool to facilitate clinical reasoning discussion for PEM providers.

METHODS

We created a case-based web-based discussion tool for PEM clinicians and fellows to post and discuss cases. We examined website analytics for site use and collected user survey data over a 3-year period to assess the use and acceptability of the tool.

RESULTS

The learning tool had more than 30,000 site visits and 172 case comments for the 55 published cases over 3 years. Self-reported engagement with the learning tool varied inversely with clinical experience in PEM. The tool was relevant to clinical practice and useful for learning PEM for most respondents. The most experienced clinicians were more likely than fellows to report posting commentary, although absolute rate of commentary was low.

CONCLUSIONS

An asynchronous method of case presentation and web-based commentary may present an acceptable way to supplement clinical experience and traditional education methods for sharing clinical reasoning.

Student perception and assessment outcomes using a pilot condensed format ("boot camp") in a Fixed Prosthodontics course

INTRODUCTION

The purpose of this study was to assess student perception as well as course outcomes (final written examination grades) when using a pilot condensed format in an undergraduate Fixed Prosthodontics course, which was implemented as a response to the global pandemic of Covid-19.

MATERIALS AND METHODS

The course was delivered in a condensed format, with a total of 28 direct contact hours in the Simulation Clinic within a 4 day period. Asynchronous remote learning was employed for the didactic portion of the course. Students completed surveys before and after the course, to assess their perception of the condensed format, and written examination grades were compared with previous years' grades. Data were entered in an Excel database (Microsoft Excel 2016) and analysed using a statistical analysis software program (IBM SPSS Statistics, v26; IBM Corp). The level of significance was set to α = 0.05.

RESULTS

Overall, student perception of the condensed format was positive. At the beginning of the course, female students had less confidence in their skills compared to male students (p < .05). Written examination grades were significantly lower compared to previous years' grades (p = .04).

CONCLUSION

The use of a condensed format can allow a course to be delivered in smaller student cohorts and provides the ability to reduce the total number of direct contact hours allotted to the course, creating space within the curriculum. Student perception of this format was generally positive. However, written examination scores were negatively impacted, indicating possible knowledge gaps resulting from the condensed course format. More studies are needed to assess the effect of the various curricular modifications that have been implemented due to the Covid-19 pandemic.

Surgical Society Podcasts: A Novel Way to Engage and Educate the Community

BACKGROUND

Podcasts are increasingly being utilized in the surgical field as an asynchronous educational resource. This article discusses podcasts devoted to the field of surgery and their growing contribution to surgical education.

METHODS

We provide examples of current podcasts and their varied structures, including those that distribute clinical and educational content, discuss recent literature and advancements, interview leaders in the field, and/or showcase unique perspectives on topics such as career development, diversity, and wellness.

RESULTS AND CONCLUSIONS

Podcasts generated from surgical societies stand on unique ground to educate and engage the surgical community.

Moving a Flipped Class Online To Teach Python to Biomedical Ph.D. Students during COVID-19 and Beyond

While quantitative analytical skills have always been a part of modern biomedical training, the big data revolution and digital research environment have increased the importance of computational approaches for biomedical graduate education. To address this growing need, Ph.D. programs have explored ways to integrate quantitative training into their existing curricula. However, these attempts have been hindered by limitations on total instructional time, faculty perceptions, and scalability. Here, we describe a flipped approach that combined a preexisting online course with group problem solving sessions to effectively and efficiently teach biomedical Ph.D. students key concepts in the use of the Python programming language for research. Following the COVID-19 related shutdowns in March 2020, we successfully adapted this approach to an all-online version where the formerly in-person problem-solving sessions occurred in small groups over Zoom. We found that students in both in-person and remote flipped formats showed increased confidence using Python and related this to their thesis research. Following the shift to the fully remote format, the lack of a physically present instructor seemed to increase students' reliance on their classmates, which in turn promoted peer learning and support. This flexible, scalable approach to computational training may address the needs of many biomedical Ph.D. programs.

The COVID-19 Elective for Pediatric Residents: Learning About Systems-Based Practice During a Pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has prompted pediatric residency programs to adjust the delivery of educational curricula and to update content relevant to the pandemic.

OBJECTIVE

In this descriptive paper, we present how we rapidly developed and implemented a COVID-19 pandemic elective for pediatric residents.

METHODS

This curriculum was established at a single tertiary care children's hospital in June 2020. We used the ADDIE (analysis, design, development, implementation, evaluation) framework to develop a two-week elective (30 hours) consisting of six flexibly scheduled modules. We administered post-elective surveys and exit interviews to solicit feedback to improve the elective and obtain effectiveness of our educational interventions.

RESULTS

We developed an asynchronous online COVID-19 Elective for Pediatric Residents. The curriculum modules focus on pathophysiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the disaster management ecosystem, simulation of clinical care, mental health ramifications, and public health consequences. We also include six in-situ experiences (visits to a drive-through COVID-19 testing site, testing laboratory and local public health department, a simulation of a critically ill child, and meetings with emergency managers and social workers) to solidify learning and allow for further reflection. To date, eight participants have taken the elective. All participants strongly agreed on a five-point Likert item survey that the elective enhanced their knowledge in current evidence-based literature for COVID-19, disaster preparedness, hospital response, management of the critically ill child, and mental and public health ramifications. All participants agreed this curriculum was relevant to and will change their practice.

CONCLUSIONS

We demonstrate how a COVID-19 elective for pediatric residents could be quickly developed and implemented. The pilot results show that pediatric trainees value asynchronous learning, supplemented by relevant in-situ experiences. Moreover, these results suggest that this curriculum provides needed disaster response and resiliency education for pediatric residents.

Podcast-Based Learning in Otolaryngology: Availability, Breadth, and Comparison with Other Specialties

OBJECTIVES/HYPOTHESIS

Studies across multiple specialties of medical students, residents, and attending physicians demonstrate increased retention, breadth of knowledge, and literature awareness when podcasts are used as an adjunctive educational tool. This Contemporary Review aims to 1) quantify podcast availability and episode frequency for medical learners across a broad range of specialties, and 2) compare these metrics between otolaryngology-specific podcasts with those of other specialties.

DATA SOURCES

Top five podcast platforms: Spotify (Stockholm, Sweden 2006), Apple Podcasts (Cupertino, CA 2012), Google Podcasts (Mountain View, CA 2018), Stitcher (San Francisco, CA 2008), and TuneIn (San Francisco, CA 2002).

METHODS

The selected podcast platforms were queried with a comprehensive set of keywords and manually searched for medically-relevant podcasts. Specialty, content, and number of episodes annually for the last 10 years were recorded for each podcast.

RESULTS

Otolaryngology has a comparable number of podcasts and breakdown of podcast category compared to other specialties, but reduced total episodes and episode frequency compared to other specialties. This may limit otolaryngologists' ability to engage in this validated form of medical education.

CONCLUSIONS

Podcast-based education provides a valuable resource for medical professionals to reinforce learning, broaden general knowledge base, and stay updated on current literature, particularly in light of increased demand for mobile and on-demand learning options. There is room for an increased number of podcasts and, particularly, increased episode frequency within the field of otolaryngology to extend these benefits to otolaryngologists and otolaryngologists in training. Laryngoscope, 131:E2131-E2138, 2021.

A preclinical hybrid curriculum and its impact on dental student learning outcomes

OBJECTIVES

The purpose of this study is to measure how the implementation of an online, preclinical hybrid curriculum impacts dental student clinic readiness, the outcomes of grades, critical thinking skills, and student and faculty perceptions respectively.

METHODS

This longitudinal comparative and descriptive study used objective data and subjective (survey) data for 4 dental class cohorts. Groups A and B experienced a traditional lecture-based curriculum, while Groups C and D experienced a hybrid curriculum that was lecture-free and implemented active learning. The Health Sciences Reasoning Test (HSRT), an objective assessment, was used to measure students' critical thinking skills.

RESULTS

Dental student outcomes have either remained steady or improved with the transition to a new hybrid curriculum. According to the student and faculty survey results, the hybrid curriculum promoted student learning, independence, critical thinking, initiative and self-motivation, and clinic practice readiness. Group C (N = 68) Total Online Platform mean scores demonstrated a significant and moderately strong correlation with the preclinical course mean grades (r = 0.68, P = 0.00). Group D HSRT (n = 63) for Attempt 1 (end of year 1) and Attempt 2 (end of Year 2) paired T test resulted in HSRT Overall (mean difference = -2.27, SD = 7.21, t = -2.5, P = 0.02) for the second preclinical year.

CONCLUSION

The hybrid curricular approach afforded many benefits. Faculty took an active role in imparting knowledge when compared to the lecture hall. Having students immersed in continual assessment through an online adaptive platform and active learning promoted self-motivation, deeper learning, applied knowledge, and discouraged superficial memorization.

Parasitology Education Before and After the COVID-19 Pandemic

The COVID-19 pandemic has disrupted parasitology curricula worldwide, which is expected to lead to the reshaping of parasitology education. Here, we share our experiences of remote teaching and learning of veterinary parasitology and discuss opportunities offered by remote teaching during COVID-19 lockdowns, enabling the development of interactive online parasitology courses.

An Asynchronous Curriculum for Teaching Practical Interpretation Skills of Clinical Images to Residents in Emergency Medicine

BACKGROUND

Interpretation of radiologic images is a critical skill for resident physicians in emergency medicine (EM), however, few training programs offer formal training in this realm. Time and money also need to be considered when adding to the curriculum of trainees.

OBJECTIVE

We sought to determine the utilization and benefit of an asynchronous curriculum in the interpretation of diagnostic imaging.

METHODS

Radiologic images were obtained from emergency department patients and presented to the trainees on a weekly basis from April to December 2017; discussion questions regarding the images were posed, all via the online workplace platform Slack. Trainees were surveyed prior to and 8 months after initiation of the curriculum to ascertain their confidence with radiologic image interpretation and their use of Slack.

RESULTS

Of the 36 potential resident physician participants in this study, 31 (86%) completed the pre-intervention survey and 28 (78%) completed the post-intervention survey. The curriculum was found to be beneficial to all respondents (100%) and increased their confidence with image interpretation from 2.93 ± 0.89 pre-intervention (5-point Likert scale) to 3.46 ± 0.83 post-intervention (p < 0.02). Seventy-five percent noted that they viewed the material "often" or "anytime new material was posted."

CONCLUSIONS

Use of an asynchronous curriculum in image interpretation increased the confidence of trainees and was well-utilized. The implications of this are far-reaching, given that a similar intervention could be undertaken for any topic in any specialty in medicine, and with no cost of money or didactic time.

A Mobile Learning Module to Support Interprofessional Knowledge Construction in the Health Professions

Objective. To develop and evaluate a mobile learning module to support knowledge construction between medical and pharmacy students through structured dialogue prompts. Methods. Rheumatologists and pharmacists collaboratively developed a two-week, case-based, asynchronous interprofessional learning module that was delivered via a mobile app and focused on collaborative medication management of a complex case involving a patient with systemic lupus erythematosus. The clinical case evolved over three phases: diagnosis, initial treatment, and medication-related complications. Dialogue prompts were incorporated in each phase as a mechanism to support knowledge construction among learners. Pharmacy and medical student pairs were randomized to receive either high guidance or low guidance prompts for collaborative learning. The student pairs worked together, asynchronously, online, to develop three collaborative care plans. The evaluation of the learning module to support knowledge construction included: analysis of text-based dialogue coded for knowledge construction phases; the accuracy and completeness of the three collaborative care plans; and quantitative and qualitative participant feedback. Results. Sixteen pairs of medical and pharmacy students (n=32) participated. Pairs who received high guidance engaged in all phases of knowledge construction more often than pairs who received low guidance. Guidance phase did not differentially impact collaborative care plan scores. Ninety-eight percent of students agreed or strongly agreed that the module improved their clinical reasoning, interprofessional communication, and knowledge of systemic lupus erythematosus. Conclusion. The knowledge construction framework can guide the design and evaluation of educational interventions such as a mobile learning module to support knowledge construction among health professionals.

COVID-19 pandemic: Early effects on pediatric rehabilitation medicine training

PURPOSE

The COVID-19 pandemic hastened the need for graduate medical education (GME) innovation, resulting in the creation of multiple pediatric rehabilitation medicine (PRM) e-learning initiatives. There has been a paucity of data regarding trainee perceptions regarding quickly developed new methods of learning during the pandemic. This study explored PRM trainee perceptions of e-learning and effects of the pandemic on education.

METHODS

Questionnaire study with data collected via REDCap.

RESULTS

Greater than half of PRM trainees (56.6%, 30/53) responded. Most respondents reported that the virtual lectures series (79.3%), journal club (78.9%), and virtual arts initiatives (75.0%) were valuable to their education. Common benefits noted included access to subject experts, networking, lecture recording, and location flexibility. Common concerns included lack of protected time, virtual platform fatigue, and decreased engagement. Most respondents were not redeployed. Relative to before the pandemic, less satisfaction with clinical education (70.0%) and greater satisfaction with non-clinical education (60.0%) was reported. The majority of graduating trainees felt positively (83.3%) and 16.7% were neutral regarding confidence to graduate.

CONCLUSION

Trainees perceived national e-learning as valuable to their education, especially due to the access to expert leaders around the nation. Future work should explore ways to overcome barriers and optimize benefits of GME and PRM e-learning.

Video delivery of toxicology educational content versus textbook for asynchronous learning, using acetaminophen overdose as a topic

Objectives: Advances in technology have brought with them innovations in delivery of medical educational content; for example, audio and video podcasts, flipped classroom learning, and e-books. These new modalities may be useful for delivery of content asynchronously, as an adjunct to traditional lecture-based and bedside clinical teaching. Here, we measured the differences in knowledge acquisition between medical students using a video-based content delivery method and students using a traditional method of asynchronous content delivery (a textbook chapter). We also measured student preferences regarding asynchronous content delivery. Methods: A 4.5-minute educational video was created by a content expert using VideoScribe software. Acetaminophen toxicity was selected as the sample topic. Survey Monkey software was used to create a pre-test, post-test, and to gather data regarding student preferences. Students were given the pre-test, then they were randomized to either read a chapter on acetaminophen overdose from an emergency medicine reference text or to view the video; they were then given the post-test and the preferences survey. The results were then categorized and analysed using descriptive statistics and linear regression. Results: Sixty-nine student responses were initiated, 14 of whom did not complete the full survey, leaving 55 students who were included in the final analysis. Fifteen first year, 27 second-year, 8 third-year, and 5 fourth-year students participated. Twenty-eight students were randomized to reading the textbook chapter, and 31 were randomized to view the video; 4 students in the textbook group did not finish the educational activity. On average, students who took the video training correctly answered 1.1 (95% CI: 0.1-2.2, p = .03) more questions correctly after adjusting for pretest score and year in medical school than those who read the textbook chapter. A preference for watching a video over reading a textbook chapter was expressed by 78.4% of students, while 98% of students either agreed or strongly agreed with the statement that they would be comfortable using the internet to learn new concepts. No students reported that they were very satisfied and 57% of students reported being satisfied reading the textbook chapter, while 93.3% were either satisfied or very satisfied viewing the video. Conclusions: Video delivery of educational content was associated with higher student satisfaction and relative improvement in score compared to textbook. Students overall expressed comfort using the internet and new technology to obtain new medical education. The authors were involved with creation of the video and quiz, which may confound results. Future exploration into retention of knowledge could be warranted.

Asynchronous learning: student utilization out of sync with their preference

BACKGROUND

Asynchronous learning is gaining popularity. Data are limited regarding this learning method in medical students rotating in emergency medicine (EM). In EM, faculty time is limited to give in-person lectures. The authors sought to create an online curriculum that students could utilize as an additional learning modality.

OBJECTIVE

The goal was to evaluate effectiveness, participation, and preference for this mode of learning.

METHODS

We developed five online, narrated PowerPoint presentations. After orientation, access to the online curriculum was provided to the students, which they could review at their leisure.

RESULTS

One hundred and seven fourth-year medical students participated. They reported the curriculum to be of high quality. Pretest scores were similar for those that viewed all lectures - compliant group (CG) (9.5 [CI 4.8-14.1]) and those that did not view any - non-compliant group (NCG) (9.6 [CI 5.9-13.4]). There was no statistical significant difference in posttest scores between the groups although there was improvement overall: CG 14.6 (CI 6.9-22.1); NCG 11.4 (CI 5.7-17.1). A majority (69.2%) favored inclusion of asynchronous learning, but less than a quarter (22.4%) reported viewing all five modules and more than a third (36.4%) viewed none.

CONCLUSION

Despite student-expressed preference for an online curriculum, they used the online resource less than expected. This should give pause to educators looking to convert core EM topics to an online format. However, when high-quality online lectures are utilized as a learning tool, this study demonstrates that they had neither a positive nor a negative impact on test scores.

Why internet-based education?

This essay illustrates five ways that Internet-based higher education can capitalize on fundamental principles of learning. Internet-based education can enable better mastery through distributed (shorter, more frequent) practice rather than massed (longer, less frequent) practice; it can optimize performance because it allows students to learn at their peak time of their day; it can deepen memory because it requires cheat-proof assignments and tests; it can promote critical thinking because it necessitates intellectual winnowing and sifting; and it can enhance writing skills by requiring students to write frequently and for a broad audience.

Asynchronous vs didactic education: it's too early to throw in the towel on tradition

BACKGROUND

Asynchronous, computer based instruction is cost effective, allows self-directed pacing and review, and addresses preferences of millennial learners. Current research suggests there is no significant difference in learning compared to traditional classroom instruction. Data are limited for novice learners in emergency medicine. The objective of this study was to compare asynchronous, computer-based instruction with traditional didactics for senior medical students during a week-long intensive course in acute care. We hypothesized both modalities would be equivalent.

METHODS

This was a prospective observational quasi-experimental study of 4th year medical students who were novice learners with minimal prior exposure to curricular elements. We assessed baseline knowledge with an objective pre-test. The curriculum was delivered in either traditional lecture format (shock, acute abdomen, dyspnea, field trauma) or via asynchronous, computer-based modules (chest pain, EKG interpretation, pain management, trauma). An interactive review covering all topics was followed by a post-test. Knowledge retention was measured after 10 weeks. Pre and post-test items were written by a panel of medical educators and validated with a reference group of learners. Mean scores were analyzed using dependent t-test and attitudes were assessed by a 5-point Likert scale.

RESULTS

44 of 48 students completed the protocol. Students initially acquired more knowledge from didactic education as demonstrated by mean gain scores (didactic: 28.39% ± 18.06; asynchronous 9.93% ± 23.22). Mean difference between didactic and asynchronous = 18.45% with 95% CI [10.40 to 26.50]; p = 0.0001. Retention testing demonstrated similar knowledge attrition: mean gain scores -14.94% (didactic); -17.61% (asynchronous), which was not significantly different: 2.68% ± 20.85, 95% CI [-3.66 to 9.02], p = 0.399. The attitudinal survey revealed that 60.4% of students believed the asynchronous modules were educational and 95.8% enjoyed the flexibility of the method. 39.6% of students preferred asynchronous education for required didactics; 37.5% were neutral; 23% preferred traditional lectures.

CONCLUSIONS

Asynchronous, computer-based instruction was not equivalent to traditional didactics for novice learners of acute care topics. Interactive, standard didactic education was valuable. Retention rates were similar between instructional methods. Students had mixed attitudes toward asynchronous learning but enjoyed the flexibility. We urge caution in trading in traditional didactic lectures in favor of asynchronous education for novice learners in acute care.