Impact of teaching and assessment format on electrocardiogram interpretation skills

Medical Education 2010: 44 : 731–740 Objectives Interpretation of the electrocardiogram (ECG) is a core clinical skill that should be developed in undergraduate medical education. This study assessed whether small‐group peer teaching is more effective than lectures in enhancing medical students’ ECG interpretation skills. In addition, the impact of assessment format on study outcome was analysed. Methods Two consecutive cohorts of Year 4 medical students (n = 335) were randomised to receive either traditional ECG lectures or the same amount of small‐group, near‐peer teaching during a 6‐week cardiorespiratory course. Before and after the course, written assessments of ECG interpretation skills were undertaken. Whereas this final assessment yielded a considerable amount of credit points for students in the first cohort, it was merely formative in nature for the second cohort. An unannounced retention test was applied 8 weeks after the end of the cardiovascular course. Results A significant advantage of near‐peer teaching over lectures (effect size 0.33) was noted only in the second cohort, whereas, in the setting of a summative assessment, both teaching formats appeared to be equally effective. A summative instead of a formative assessment doubled the performance increase (Cohen’s d 4.9 versus 2.4), mitigating any difference between teaching formats. Within the second cohort, the significant difference between the two teaching formats was maintained in the retention test (p = 0.017). However, in both cohorts, a significant decrease in student performance was detected during the 8 weeks following the cardiovascular course. Conclusions Assessment format appeared to be more powerful than choice of instructional method in enhancing student learning. The effect observed in the second cohort was masked by an overriding incentive generated by the summative assessment in the first cohort. This masking effect should be considered in studies assessing the effectiveness of different teaching methods.     

A comparison of different contraceptive curriculums and their impact on knowledge retention and learning skills of medical students

OBJECTIVE: The purpose of this study is to assess the long-term knowledge retention and learning skills among third year medical students who had been taught about contraception 1 year previously. STUDY DESIGN: In 2002-2003, 150 third-year medical students were taught contraception in either an interactive or a standard format. Students completed exams at 2-4 weeks and 1 year after sessions. Scores were compared to determine long-term knowledge retention (paired t test). At 1 year, students assessed the long-term impact of the contraceptive lecture (visual analogue scales). RESULTS: This study had a 40% response rate (60/150, interactive 34/77, standard 26/73). Overall, test scores decreased three points (8.6%), with an average test score of 22/35 (p<.01) at 1 year. Follow-up test scores were equivalent between lecture groups (p=.64). Use of a contraceptive resource tended to be higher in the interactive group (50% vs. 27%, p=.08). Students requested that more time be devoted to teaching contraception (78%). CONCLUSION: Both teaching formats are equivalent in their impact on long-term knowledge retention.     

Authenticity of instruction and student performance: a prospective randomised trial

Medical Education 2011: 45 : 807–817 Objectives This study aimed to investigate the relationship between the authenticity of instructional formats and outcome measures within a pre‐clerkship clinical reasoning course. Methods We conducted a randomised, prospective, crossover study with Year 2 medical students taking a pre‐clerkship clinical reasoning course. Students were randomised to small groups and exposed to three formats of differing instructional authenticity (paper case, DVD presentation, standardised patient [SP] presentation) across three subject areas (abdominal pain, anaemia, polyuria). Three student cohorts were taught using one instructional format per subject area so that each cohort received a different instructional format for each of the three subject areas. Outcome measures (objective structured clinical examination, video quiz, written examination) were selected to determine the effect of each instructional format on the clinical reasoning of students. Results Increasingly authentic instructional formats did not significantly improve clinical reasoning performance across all outcome measures and subject areas. However, the results of the video quiz showed significant differences in the anaemia subject area between students who had been instructed using the paper case and live SP‐based formats (scores of 47.4 and 57.6, respectively; p = 0.01) and in the abdominal pain subject area, in which students instructed using the DVD format scored higher than students instructed using either the paper case or SP‐based formats (scores of 41.6, 34.9 and 31.2, respectively; p = 0.002). Conclusions Increasing the authenticity of instructional formats does not appear to significantly improve clinical reasoning performance in a pre‐clerkship course. Medical educators should balance increases in authenticity with factors such as cognitive load, subject area and learner experience when designing new instructional formats.     

Videotaped vs traditional lectures for medical students

Closed-circuit television (CCTV) provides medical departments with alternatives in instructional formats. Concern, however, has been voiced about teaching via TV because the medium itself might cause inattention. This study investigated whether TV will lower the test scores of medical students. Sixty-one students were randomly divided into two groups. The lecture (control) group received the information via traditional lectures, including use of 2”× 2” transparencies. The video group received concurrently the same information via CCTV. Multiple-choice examinations were given after each of the six sessions. The cumulative mean scores were similar: lecture group = 87.56%, video group = 87.99%, i.e., no significant difference (P=0.77). To detect attitudinal differences toward the two formats, the students were surveyed at the end of the series and intragroup agreement on specific questions was calculated. The students rated the lecture format more highly. In response to the question ‘Did the audiovisual materials used by the instructor aid your learning?’, the mean rating from the lecture group was 7.37 (scale of 0–9) compared to a mean rating of 5.93 from the video group (P< 0.0003).     

A Randomized Controlled Trial of Simulation-Based Teaching versus Traditional Instruction in Medicine: A Pilot Study among Clinical Medical Students

Objective: To compare simulator-based teaching with traditional instruction among clinical medical students. Methods: Randomized controlled trial with written pre-post testing. Third-year medical students (n = 38) received either a myocardial infarction (MI) simulation followed by a reactive airways disease (RAD) lecture, or a RAD simulation followed by an MI lecture. Results: Mean pre-post test score improvement was seen across teaching modalities (overall change score [simulation] = 8.8 [95% CI = 2.3–15.3], pretest [62.7]; change score [lecture] = 11.3 [95% CI = 5.7–16.9], pretest [59.7]). However, no significant differences were observed between simulator-based teaching and lecture, in either subject domain. Conclusions: After a single instructional session for clinical medical students, differences between simulator-based teaching and lecture could not be established by the written test protocols used in this pilot. Future studies should consider the effects of iterative exposure assessed by clinical performance measures across multiple centers.     

Applying multimedia design principles enhances learning in medical education

Medical Education 2011: 45 : 818–826 Context The Association of American Medical Colleges’ Institute for Improving Medical Education’s report entitled ‘Effective Use of Educational Technology’ called on researchers to study the effectiveness of multimedia design principles. These principles were empirically shown to result in superior learning when used with college students in laboratory studies, but have not been studied with undergraduate medical students as participants. Methods A pre‐test/post‐test control group design was used, in which the traditional‐learning group received a lecture on shock using traditionally designed slides and the modified‐design group received the same lecture using slides modified in accord with Mayer’s principles of multimedia design. Participants included Year 3 medical students at a private, midwestern medical school progressing through their surgery clerkship during the academic year 2009–2010. The medical school divides students into four groups; each group attends the surgery clerkship during one of the four quarters of the academic year. Students in the second and third quarters served as the modified‐design group (n = 91) and students in the fourth‐quarter clerkship served as the traditional‐design group (n = 39). Results Both student cohorts had similar levels of pre‐lecture knowledge. Both groups showed significant improvements in retention (p < 0.0001), transfer (p < 0.05) and total scores (p < 0.0001) between the pre‐ and post‐tests. Repeated‐measures anova analysis showed statistically significant greater improvements in retention (F = 10.2, p = 0.0016) and total scores (F = 7.13, p = 0.0081) for those students instructed using principles of multimedia design compared with those instructed using the traditional design. Conclusions Multimedia design principles are easy to implement and result in improved short‐term retention among medical students, but empirical research is still needed to determine how these principles affect transfer of learning. Further research on applying the principles of multimedia design to medical education is needed to verify the impact it has on the long‐term learning of medical students, as well as its impact on other forms of multimedia instructional programmes used in the education of medical students.     

A randomised trial of an online lecture with and without audio

Objective  To determine the impact of adding audio-feed to an online lecture on screening given to medical students who were participating in an outpatient clerkship.
Design  Prospective, randomised, controlled study.
Setting  Vanderbilt University School of Medicine, Nashville and Wake Forest Medical School, Winston-Salem.
Participants  A total of 59 Years 3 and 4 medical students.
Main outcome measures  Students' use of time, satisfaction with the lecture experience, and knowledge.
Educational intervention  The online lecture was developed at Vanderbilt University. At Vanderbilt, 16 Year 4 medical students were randomised to the lecture on screening with audio and 17 Year 4 medical students were randomised to the same lecture without audio. At Wake Forest, 13 Year 3 medical students were randomised to the lecture on screening with audio and 13 Year 3 students were randomised to the same lecture without audio.
Results  The audio lecture required 20 more minutes to complete than the non-audio lecture. Students in the audio group were more satisfied with their experience than students in the non-audio group. Students in the audio-feed group achieved a trend for higher post-intervention knowledge scores, with the difference attributed to the students at Vanderbilt.
Conclusion  Audio narration is an important aspect of an online lecture. The distribution of online lectures to students at different sites and different training levels requires further study.     

A randomised controlled trial of the effects of mindfulness practice on medical student stress levels

Medical Education 2011: 45 : 381–388 Objective This study aimed to determine whether the practice of mindfulness reduces the level of stress experienced by senior medical students. Methods We carried out a multicentre, single‐blinded, randomised controlled trial with intention‐to‐treat analysis in three clinical schools attached to the University of Tasmania, Hobart, Tasmania. Participants included 66 medical students in their final 2 years of study in 2009. Participants were block‐randomised to either an intervention or a usual care control group. The intervention used an audio CD of guided mindfulness practice designed and produced for this trial. Participants were advised to use the intervention daily over the 8 weeks of the trial. All participants completed two self‐report questionnaires, at baseline and at 8 weeks, respectively. The intervention group also completed a questionnaire at 16 weeks to provide follow‐up data. The primary outcome measure was the difference over time in scores on the Perceived Stress Scale (PSS). The secondary outcome measure referred to differences over time in scores on the subscales of the Depression, Anxiety and Stress Scale (DASS). Results Mean baseline scores on the PSS and the stress component of the DASS were 15.7 (maximal score of 40) and 13.2 (maximal score of 42), respectively, both of which exceed scores in age‐matched normative control data. Using multivariable analysis, participants in the intervention group demonstrated significant reductions in scores on the PSS (? 3.44, 95% confidence interval [CI] ? 6.20 to ? 0.68; p < 0.05) and the anxiety component of the DASS (? 2.82, 95% CI ? 4.99 to ? 0.64; p < 0.05). A borderline significant effect was demonstrated on the stress component of the DASS (? 3.69, 95% CI ? 7.38 to 0.01; p = 0.05). Follow‐up at 8 weeks post‐trial revealed that the effect was maintained. Conclusions Mindfulness practice reduced stress and anxiety in senior medical students. Stress is prevalent in medical students and can have adverse effects on both student health and patients. A simple, self‐administered, evidence‐based intervention now exists to manage stress in this at‐risk population and should be widely utilised.     

Three‐dimensional visualisation improves understanding of surgical liver anatomy

Medical Education 2010: 44 : 936–940 Objectives Three‐dimensional (3‐D) representation is thought to improve understanding of complex spatial interactions and is being used more frequently in diagnostic and therapeutic procedures. It has been suggested that males benefit more than females from 3‐D presentations. There have been few randomised trials to confirm these issues. We carried out a randomised trial, based on the identification of complex surgical liver anatomy, to evaluate whether 3‐D presentation has a beneficial impact and if gender differences were evident. Methods A computer‐based teaching module (TM) was developed to test whether two‐dimensional (2‐D) computed tomography (CT) images or 3‐D presentations result in better understanding of liver anatomy. Following a PowerPoint lecture, students were randomly selected to participate in computer‐based testing which used either 2‐D images presented as consecutive transversal slices, or one of two 3‐D variations. In one of these the vessel tree of portal and hepatic veins was shown in one colour (3‐D) and in the other the two vessel systems were coloured differently (3‐Dc). Participants were asked to answer 11 medical questions concerning surgical anatomy and four questions on their subjective assessment of the TM. Results Of the 160 Year 4 and 5 medical students (56.8% female) who participated in this prospective randomised trial, students exposed to 3‐D presentation performed significantly better than those exposed to 2‐D images (p < 0.001). Comparison of the number of correct answers revealed no significant differences between the 3‐D and 3‐Dc modalities p > 0.1). Male students gave significantly more correct answers in the 3‐D and 3‐Dc modalities than female students (p < 0.03). The gender difference observed in both 3‐D modalities was not evident in the 2‐D group (p = 0.21). Conclusions This study showed that 3‐D imaging significantly improved the identification of complex surgical liver anatomy. Male students benefited significantly more than female students from 3‐D presentations. Use of colour in 3‐D presentation did not improve student performance.     

The effectiveness of self-directed learning in health professions education: a systematic review

Medical Education 2010: 44 : 1057–1068 Objectives Given the continuous advances in the biomedical sciences, health care professionals need to develop the skills necessary for life‐long learning. Self‐directed learning (SDL) is suggested as the methodology of choice in this context. The purpose of this systematic review is to determine the effectiveness of SDL in improving learning outcomes in health professionals. Methods We searched MEDLINE, EMBASE, ERIC and PsycINFO through to August 2009. Eligible studies were comparative and evaluated the effect of SDL interventions on learning outcomes in the domains of knowledge, skills and attitudes. Two reviewers working independently selected studies and extracted data. Standardised mean difference (SMD) and 95% confidence intervals (95% CIs) were estimated from each study and pooled using random‐effects meta‐analysis. Results The final analysis included 59 studies that enrolled 8011 learners. Twenty‐five studies (42%) were randomised. The overall methodological quality of the studies was moderate. Compared with traditional teaching methods, SDL was associated with a moderate increase in the knowledge domain (SMD 0.45, 95% CI 0.23–0.67), a trivial and non‐statistically significant increase in the skills domain (SMD 0.05, 95% CI ? 0.05 to 0.22), and a non‐significant increase in the attitudes domain (SMD 0.39, 95% CI ? 0.03 to 0.81). Heterogeneity was significant in all analyses. When learners were involved in choosing learning resources, SDL was more effective. Advanced learners seemed to benefit more from SDL. Conclusions Moderate quality evidence suggests that SDL in health professions education is associated with moderate improvement in the knowledge domain compared with traditional teaching methods and may be as effective in the skills and attitudes domains.     

Spaced education improves the retention of clinical knowledge by medical students: a randomised controlled trial

Purpose Medical knowledge learned by trainees is often quickly forgotten. How can the educational process be tailored to shift learning into longer‐term memory? We investigated whether ‘spaced education’, consisting of weekly e‐mailed case scenarios and clinical questions, could improve the retention of students' learning. Methods During the 2004–5 surgery clerkships, 3rd‐year students completed a mandatory 1‐week clinical rotation in urology and validated web‐based teaching programme on 4 core urology topics. Spaced educational e‐mails were constructed on all 4 topics based on a validated urology curriculum. Each consisted of a short clinically relevant question or clinical case scenario in multiple‐choice question format, followed by the answer, teaching point summary and explanations of the answers. Students were randomised to receive weekly e‐mailed case scenarios in only 2 of the 4 urology topics upon completion of their urology rotation. Students completed a validated 28‐item test (Cronbach's α = 0.76) on all 4 topics prior to and after the rotation and at the end of the academic year. Results A total of 95 of 133 students (71%) completed the end‐of‐year test. There were no significant differences in baseline characteristics between randomised cohorts. Spaced education significantly improved composite end‐of‐year test scores (P < 0.001, paired t‐test). The impact of the spaced educational e‐mails was largest for those students who completed their urology education 6–8 and 9–11 months previously (Cohen's effect sizes of 1.01 and 0.73, respectively). Conclusion Spaced education consisting of clinical scenarios and questions distributed weekly via e‐mail can significantly improve students' retention of medical knowledge.     

Does teaching style matter? A randomised trial of group discussion versus lectures in orthopaedic undergraduate teaching

OBJECTIVES: Educational theory suggests that lectures may not be the best way to impart knowledge to students. The aim of this study was to compare the use of didactic lectures with that of interactive discussion sessions in undergraduate teaching of orthopaedics and trauma. METHODS: A total of 77 medical students were assessed in 3 consecutive cohorts. The students were randomised into 2 groups. The first group received a series of 12 formal lectures. The second group covered the same topics in 12 group-discussion sessions with self-directed learning. RESULTS: The students in the interactive discussion group rated the presentation of their teaching more highly than those in the lecture group (P = 0.003). However, there was no difference in their rating of the content of the sessions. The students in the discussion group also performed better on their end-of-placement written test (P = 0.025). CONCLUSIONS: We found that interactive teaching styles are more popular than didactic lectures in undergraduate orthopaedic and trauma teaching. We also found some evidence that knowledge retention is better following an interactive teaching style.     

Reflection as a strategy to foster medical students' acquisition of diagnostic competence

Medical Education 2012: 46 : 464–472 Objectives Developing diagnostic competence in students is a major goal of medical education, but there is little empirical evidence on instructional strategies that foster the acquisition of this competence. The aim of this study was to investigate the effects of structured reflection compared with the generation of immediate or differential diagnosis while practising with clinical cases on learning clinical diagnosis. Methods This was a three‐phase experimental study. During a learning phase, 46 Year 4 students diagnosed six clinical cases under different experimental conditions: structured reflection, immediate diagnosis, or differential diagnosis. This was followed by an immediate test and a delayed test administered 1 week later. Each test consisted of diagnosing four different cases of diseases presented in the learning phase. Performance in diagnosing these new cases was used as a measure of learning. Results Repeated‐measures analysis of variance on the mean diagnostic accuracy scores (range: 0–1) showed a significant interaction between performance moment (i.e. performance in the learning phase and on each test) and instructions followed during the learning phase (p = 0.003). Follow‐up analyses of this interaction showed that diagnostic performance did not differ between conditions in the learning phase. On the immediate test, scores in the reflection condition (mean = 0.48, 95% confidence interval [CI] 0.38–0.58) were significantly lower than scores in the differential diagnosis condition (mean = 0.62, 95% CI 0.54–0.70; p = 0.012) and marginally lower than those in the immediate diagnosis condition (mean = 0.61, 95% CI 0.52–0.70; p = 0.04). One week later, however, scores in the reflection condition (mean = 0.66, 95% CI 0.56–0.76) significantly outperformed those in the other conditions (differential diagnosis: mean = 0.48, 95% CI 0.37–0.58 [p < 0.01]; immediate diagnosis: mean = 0.52, 95% CI 0.43–0.60 [p = 0.01]). Comparisons within experimental conditions showed that performance from the immediate to the delayed test decreased in the immediate and differential diagnosis conditions (immediate diagnosis: p = 0.042; differential diagnosis: p = 0.012), but increased in the reflection condition (p = 0.003). Conclusions Structured reflection while practising with cases appears to foster the learning of clinical knowledge more effectively than the generation of immediate or differential diagnoses and therefore seems to be an effective instructional approach to developing diagnostic competence in students.     

翻转课堂在心电图教学中的应用

目的探讨翻转课堂教学模式在心电图教学中的效果。方法选有可比性的2016级精神本科(实验组)、影像本科(对照组)学生各35人,实验组学生采取翻转教学模式,对照组采取传统教学模式,利用理论知识、心电图判读考试及问卷调查对教学效果进行评估。结果实验组理论考试、心电图判读考试成绩均高于对照组,差异有统计学意义(P<0.05)。实验组对于提高了学生的主动学习能力、提高了心电图的读图能力、提高了综合运用知识能力、提高了理论知识的实际应用能力、提高了分析解决问题能力5个问题的满意度调查结果均高于对照组,差异有统计学意义(P<0.05)。结论翻转课堂教学模式可以促进学生自主学习习惯的养成,提高了学生阅读分析心电图的能力,提高了本科教育的教学质量。     

A Two-day Teacher-Training Programme for Medical Residents: Investigating the Impact on Teaching Ability

Introduction: Many of the residents who supervise medical students in clinical practice are unfamiliar with the principles of effective supervision. Training in teaching skills is therefore seen as an effective strategy to improve the quality of clinical supervision. Method: Twenty seven medical residents were matched and assigned to an experimental group (n = 14) and a control group (n = 13). The experimental group participated in a two-day workshop on teaching skills. Using standardized questionnaires, the teaching abilities of all participants were assessed anonymously by medical students, before and after the workshop, to determine for any effect of the intervention. Results: A significant improvement in the teaching abilities of the medical residents in the experimental group was observed following the workshop (t=−2.68, p=0.02). The effect size within the experimental group was large (d=1.17), indicating that the workshop led to a measurable positive change in the medical residents’ teaching abilities. The effect size estimated from the post intervention scores on teaching ability of the two groups showed a moderate improvement (d=0.57) in the experimental group compared with the control group. Discussion: Medical students rated the teaching abilities of the workshop participants after the training more highly than those of the residents in the control group. The ability to adjust teaching to the needs of the students and teach effective communication and diagnostic clinical skills were among the features that characterized effective teaching. Properly designed, teacher-training workshops could be effective and feasible methods to improve the quality of teaching by medical residents.     

Influences of deep learning,need for cognition and preparation time on open‐ and closed‐book test performance

Medical Education 2010: 44 : 884–891 Objectives The ability to master discipline‐specific knowledge is one of the competencies medical students must acquire. In this context, ‘mastering’ means being able to recall and apply knowledge. A way to assess this competency is to use both open‐ and closed‐book tests. Student performance on both tests can be influenced by the way the student processes information. Deep information processing is expected to influence performance positively. The personal preferences of students in relation to how they process information in general (i.e. their level of need for cognition) may also be of importance. In this study, we examined the inter‐relatedness of deep learning, need for cognition and preparation time, and scores on open‐ and closed‐book tests. Methods This study was conducted at the University Medical Centre Groningen. Participants were Year 2 students (n = 423). They were asked to complete a questionnaire on deep information processing, a scale for need for cognition on a questionnaire on intellectualism and, additionally, to write down the time they spent on test preparation. We related these measures to the students’ scores on two tests, both consisting of open‐ and closed‐book components and used structural equation modelling to analyse the data. Results Both questionnaires were completed by 239 students (57%). The results showed that need for cognition positively influenced both open‐ and closed‐book test scores (β‐coefficients 0.05 and 0.11, respectively). Furthermore, study outcomes measured by open‐book tests predicted closed‐book test results better than the other way around (β‐coefficients 0.72 and 0.11, respectively). Conclusions Students with a high need for cognition performed better on open‐ as well as closed‐book tests. Deep learning did not influence their performance. Adding open‐book tests to the regularly used closed‐book tests seems to improve the recall of knowledge that has to be known by heart. Need for cognition may provide a valuable addition to existing theories on learning.     

Rethinking the globalisation of problem-based learning: how culture challenges self-directed learning

Medical Education 2012: 46: 738–747 Context  Medical schools worldwide are increasingly switching to student‐centred methods such as problem‐based learning (PBL) to foster lifelong self‐directed learning (SDL). The cross‐cultural applicability of these methods has been questioned because of their Western origins and because education contexts and learning approaches differ across cultures. Objectives  This study evaluated PBL’s cross‐cultural applicability by investigating how it is applied in three medical schools in regions with different cultures in, respectively, East Asia, the Middle East and Western Europe. Specifically, it investigated how students’ cultural backgrounds impact on SDL in PBL and how this impact affects students. Methods  A qualitative, cross‐cultural, comparative case study was conducted in three medical schools. Data were collected through 88 semi‐structured, in‐depth interviews with Year 1 and 3 students, tutors and key persons involved in PBL, 32 observations of Year 1 and 3 PBL tutorials, document analysis, and contextual information. The data were thematically analysed using the template analysis method. Comparisons were made among the three medical schools and between Year 1 and 3 students across and within the schools. Results  The cultural factors of uncertainty and tradition posed a challenge to Middle Eastern students’ SDL. Hierarchy posed a challenge to Asian students and achievement impacted on both sets of non‐Western students. These factors were less applicable to European students, although the latter did experience some challenges. Several contextual factors inhibited or enhanced SDL across the cases. As students grew used to PBL, SDL skills increased across the cases, albeit to different degrees. Conclusions  Although cultural factors can pose a challenge to the application of PBL in non‐Western settings, it appears that PBL can be applied in different cultural contexts. However, its globalisation does not postulate uniform processes and outcomes, and culturally sensitive alternatives might be developed.     

A comparison of performance by medical and midwifery students in multiprofessional teaching

AIM: At Dundee University, midwifery and medical students are taught obstetrics together in a 2-week intensive course. We set out to test the hypothesis that staff time and effort could be saved by using shared resources in teaching a multidisciplinary group of students to an acceptable level. METHOD: In order to measure the knowledge gain by two different groups of students, we tested the students before and after a timetabled computer-assisted learning (CAL) session focusing on how to interpret a cardiotocograph (CTG). Also, half of each student group was given extra CTG teaching before the CAL session. RESULTS: The medical students (n=38) increased their median score from 9 to 17 after the CAL (P<0.001) but the midwifery students (n=13) only increased their median score from 12 to 14 after the CAL (n.s.). However, when given a tutorial and CAL, the post-test scores for both medical and midwifery students were similar and significantly higher than pre-test scores (median score increase from 8.5 to 18 for medical students, P<0.001, n=34, and from 9 to 16 for midwifery students, P<0.01 n=11). There was no significant knowledge gain by the medical students who undertook the additional tutorial. CONCLUSION: We conclude that shared resources could be used by medical and midwifery students to reach equivalent levels of skill in CTG interpretation. However, in order to achieve equivalence, staff time and effort was wasted as medical students were given unnecessary tuition.     

A comparison of tele-education versus conventional lectures in wound care knowledge and skill acquisition

We conducted a randomized controlled study to compare conventional lectures with tele-education for delivering wound care education. Education was delivered by the two methods simultaneously to two classes. Forty-eight paramedics received a live didactic presentation and 41 paramedics received the same lecture via videoconferencing. The participants were evaluated by a multiple-choice examination and a practical test of their wound closure skills. There were no significant differences in any category of the practical skills test, and no difference in the results of the written examination: the mean total score was was 109.0 (95% CI 105.7-112.4) in the conventional lecture group and 110.3 (95% CI 106.2-114.3) in the video group (P = 0.63). In a survey at the end of the study the live lecture group rated the overall effectiveness of teaching significantly higher than the video-based group: the median scores for effectiveness of teaching were 6.0 (IQR 5.5-6.0) in the live lecture group and 4.0 (IQR 3.0-5.0) in the video group (P < 0.001). Videoconferencing was at least as effective as live didactic presentation.