The effectiveness of webcast compared to live lectures as a teaching tool in medical school

Objective: The purpose of this study is to investigate whether webcast lectures are comparable to live lectures as a teaching tool in medical school.

Methods: Three Otolaryngology-Head&Neck Surgery (OTO-HNS) lectures were given to third year medical students through their regular academic curriculum with one group receiving lectures in a live lecture format and the other group in a webcast format. All lectures (live or webcast) were given by the same lecturer and contained identical material. Three outcome measures were used: a student satisfaction survey, performance on the OTO-HNS component of their written examination, and performance on an OTO-HNS OSCE station in the general end of year OSCE examination session.

Results: Students performance on the written examination was equal between the two groups. The webcast group outperformed the live lecture group in the OSCE station. The majority of students in the webcast group felt it was an effective learning tool for them. Most viewed the lectures more than once, and felt that this was beneficial to their learning.

Conclusion: Webcasts appear equally effective to live lectures as a teaching tool.     

The effectiveness of integration of virtual patients in a collaborative learning activity

Abstract

Background: Virtual patients (VPs) have been recently integrated within different learning activities.

Aim: To compare between the effect of using VPs in a collaborative learning activity and using VPs in an independent learning activity on students’ knowledge acquisition, retention and transfer.

Methods: For two different topics, respectively 82 and 76 dental students participated in teaching, learning and assessment sessions with VPs. Students from a female campus and from a male campus have been randomly assigned to condition (collaborative and independent), yielding four experimental groups. Each group received a lecture followed by a learning session using two VPs per topic. Students were administrated immediate and delayed written tests as well as transfer tests using two VPs to assess their knowledge in diagnosis and treatment.

Results: For the treatment items of the immediate and delayed written tests, females outperformed males in the collaborative VP group but not in the independent VP group.

Conclusion: On the female campus, the use of VPs in a collaborative learning activity is more effective than its use as an independent learning activity in enhancing students’ knowledge acquisition and retention. However, the collaborative use of VPs by itself is not enough to produce consistent results across different groups of students and attention should be given to all the factors that would affect students’ interaction.     

The effectiveness of sequencing virtual patients with lectures in a deductive or inductive learning approach

Background: Virtual patients (VPs) can be sequenced with other instructional methods in different ways.

Aim: To investigate the effect of sequencing VPs with lectures in a deductive approach, in comparison with an inductive approach, on students’ knowledge acquisition, retention, and transfer.

Methods: For two different topics, 84 out of 87 students have participated in the lecture and VP sessions. Students from female and male campuses have been randomly assigned to one of the two learning approaches (deductive and inductive), yielding four experimental groups. Each group received a lecture session and an independent VP learning activity, which either followed the lecture session in the deductive group or preceded it in the inductive group. Students were administrated knowledge acquisition and retention written tests as well as transfer tests using two new VPs.

Results: There was no significant effect for the learning approach on knowledge acquisition or retention, while for knowledge transfer, males have benefited from the inductive approach in topic 1 while in the more complex topic 2, they have benefited from the deductive approach. On the other hand, females seem to be largely unaffected by learning approach.

Conclusions: Sequencing VPs in inductive and deductive learning approaches leads to no significant differences on students’ performance when full guidance is offered in the inductive approach.     

Learning methods and strategies of anatomy among medical students in two different Institutions in Riyadh,Saudi Arabia

Abstract

Background: Anatomy instructors adopt individual teaching methods and strategies to convey anatomical information to medical students for learning. Students also exhibit their own individual learning preferences. Instructional methods preferences vary between both instructors and students across different institutions.

Aims: In attempt to bridge the gap between teaching methods and the students’ learning preferences, this study aimed to identify students’ learning methods and different strategies of studying anatomy in two different Saudi medical schools in Riyadh.

Materials and Methods: A cross-sectional study, conducted in Saudi Arabia in April 2015, utilized a three-section questionnaire, which was distributed to a consecutive sample of 883 medical students to explore their methods and strategies in learning and teaching anatomy in two separate institutions in Riyadh, Saudi Arabia.

Results: Medical students’ learning styles and preferences were found to be predominantly affected by different cultural backgrounds, gender, and level of study. Many students found it easier to understand and remember anatomy components using study aids. In addition, almost half of the students felt confident to ask their teachers questions after class. The study also showed that more than half of the students found it easier to study by concentrating on a particular part of the body rather than systems. Students’ methods of learning were distributed equally between memorizing facts and learning by hands-on dissection. In addition, the study showed that two thirds of the students felt satisfied with their learning method and believed it was well suited for anatomy.

Conclusions: There is no single teaching method which proves beneficial; instructors should be flexible in their teaching in order to optimize students’ academic achievements.     

Collaborative use of virtual patients after a lecture enhances learning with minimal investment of cognitive load

Background: The use of virtual patients (VPs), due to their high complexity and/or inappropriate sequencing with other instructional methods, might cause a high cognitive load, which hampers learning.

Aim: To investigate the efficiency of instructional methods that involved three different applications of VPs combined with lectures.

Method: From two consecutive batches, 171 out of 183 students have participated in lecture and VPs sessions. One group received a lecture session followed by a collaborative VPs learning activity (collaborative deductive). The other two groups received a lecture session and an independent VP learning activity, which either followed the lecture session (independent deductive) or preceded it (independent inductive). All groups were administrated written knowledge acquisition and retention tests as well as transfer tests using two new VPs. All participants completed a cognitive load questionnaire, which measured intrinsic, extraneous and germane load. Mixed effect analysis of cognitive load and efficiency using the R statistical program was performed.

Results: The highest intrinsic and extraneous load was found in the independent inductive group, while the lowest intrinsic and extraneous load was seen in the collaborative deductive group. Furthermore, comparisons showed a significantly higher efficiency, that is, higher performance in combination with lower cognitive load, for the collaborative deductive group than for the other two groups.

Conclusion: Collaborative use of VPs after a lecture is the most efficient instructional method, of those tested, as it leads to better learning and transfer combined with lower cognitive load, when compared with independent use of VPs, either before or after the lecture.     

Do they teach what they need to? An analysis of the impact of curriculum mapping on the learning objectives taught in a lecture series in surgery

Abstract

Introduction: Curriculum mapping shows concordances and differences between the intended and the taught curriculum. To our knowledge, no previous studies describe the effects that this mapping has on the curriculum. The aim of the present study is to map the content of a lecture series in surgery to the National Catalogue of Learning Objectives in Surgery and analyze the effects this mapping has on the content of the following lecture series.

Methods: All lecturers in the lecture series were directly observed by a minimum of two reviewers and learning objectives and the level of competence were documented. After the lecture series, the results were visualized within the catalog of learning objectives and were sent to the lecturers. In the following lecture series, learning objectives were documented correspondingly.

Results: In the first lecture series, 47% of the learning objectives were taught. After the mapping, the number of learning objectives that were taught increased to 59% (p?<?0.001). The increase was found in all surgical disciplines and in all levels of competences without any changes in the average duration of the lectures.

Conclusions: The presented method for mapping a curriculum effectively increased the number of taught learning objectives without requiring longer lecture durations.     

The introduction of large class problem-based learning into an undergraduate medical curriculum: an evaluation

When considering implementing integrated curriculum models, such as problem-based learning (PBL), concerns may be expressed about the need for increased staff resources required to deliver tutor-led small group PBL. Less staff intensive ways of supporting PBL need to be explored. We compared the outcomes of a PBL module conducted in a large class format within a lecture theatre with a module having the same defined learning outcomes delivered in small group PBL format, both supported by e-learning resources. The pre-existing 27 small groups within the whole class (n = 246) of first year students undertaking a cardiovascular basic science module at Sheffield undergraduate medical school, UK, were randomized to 22 groups undertaking the large class Integrated Learning Activity (ILA) and 5 groups to traditional small group facilitated PBL sessions. Outcome measures were: a pre-post knowledge based test, a student educational effectiveness questionnaire, and assessment of student group work and presentations. There seemed to be no significant differences in learning outcomes between the methods although it is recognized that students would prefer the small group teaching format. Within institutions where resources to support small group PBL are limited, the large group ILA format supported with e-learning techniques may be a useful alternative approach.     

An online app platform enhances collaborative medical student group learning and classroom management

Purpose: The authors presented their results in effectively using a free and widely-accessible online app platform to manage and teach a first-year pathology course at Mayo Medical School.

Methods used: The authors utilized the Google “Blogger”, “Forms”, “Flubaroo”, “Sheets”, “Docs”, and “Slides” apps to effectively build a collaborative classroom teaching and management system. Students were surveyed on the use of the app platform in the classroom, and 44 (94%) students responded.

Results: Thirty-two (73%) of the students reported that “Blogger” was an effective place for online discussion of pathology topics and questions. 43 (98%) of the students reported that the “Forms/Flubaroo” grade-reporting system was helpful. 40 (91%) of the students used the remote, collaborative features of “Slides” to create team-based learning presentations, and 39 (89%) of the students found those collaborative features helpful. “Docs” helped teaching assistants to collaboratively create study guides or grading rubrics. Overall, 41 (93%) of the students found that the app platform was helpful in establishing a collaborative, online classroom environment.

Conclusions: The online app platform allowed faculty to build an efficient and effective classroom teaching and management system. The ease of accessibility and opportunity for collaboration allowed for collaborative learning, grading, and teaching.     

Screens in the back: Medical student perspective on curriculum engagement

Abstract

Medical students in the United States are engaging less with formal classroom curricula. This shift in decreased attendance and participation is largely driven by an incentive structure in medical education focused on standardized test scores, research and letters of recommendation. In this essay, the authors describe the student experience of a preclinical lecture, struggling to balance learning about a patient with Alcohol Use Disorder with the demands of extracurricular expectations.     

How does feedback from patients impact upon healthcare student clinical skill development and learning? A systematic review

Background: A key feature of health professionals’ training, irrespective of discipline, is the acquisition and application of clinical and communication skills. Despite this, little is known about the potential role of patient feedback on this process. This systematic review aimed to answer the question: How does feedback from patients impact upon healthcare student clinical skill development and learning?

Design: Systematic review of published literature.

Methods: Electronic databases were searched for studies that explored the effects of patient feedback on student learning and were published before March 2016. Eligible articles underwent methodological evaluation using the McMaster University Critical Evaluation Forms and data extraction.

Results: A total of 237 articles were retrieved following searches of electronic databases and hand searches of reference lists. Twelve (7 quantitative, 2 qualitative, 3 mixed methods) studies met the inclusion criteria. Eleven studies reported that patient feedback improved students’ clinical skills.

Conclusion: Minimal research has explored the impact of patient feedback on student learning. The research to date suggests that direct feedback from patients may be beneficial for the development of students’ communication and clinical skills; however, the wide variety of evaluation methods and the lack of validated tools for patients to provide feedback suggest that further exploration is warranted.     

Legitimisation,personalisation and maturation: Using the experiences of a compulsory mobile curriculum to reconceptualise mobile learning

Background: Smartphone use is well established in society, with increasing acceptance in many professional workplaces. Despite the growth in mobile resources, how students and teachers benefit from these devices remains under-researched.

Aims: An exploration of student and educators views on the impact of mobile learning re-sources on placement learning experiences as part of the Leeds ‘MBChB Mobile’ programme.

Methods: Focus groups incorporating visual methodologies were undertaken with students from each year group; semi-structured interviews were undertaken with clinical teaching staff, including those who experienced the mobile programme as students themselves.

Results: Four key themes emerged. ‘Maturity of learning’, related to the way in which senior students use resources in a more nuanced way than junior colleagues. ‘Learning differently’, identified ‘personalisation’ and ‘just in time’ opportunities that mobile resources afforded. ‘Learning legitimately’ was identified by students as key to ensuring they adopted appropriate behaviours in relation to mobile learning. Using mobile resources at undergraduate level was found to ‘change learning patterns for life’.

Conclusions: There is a need to further develop the educational theory behind using mobile resources for learning. The results here suggest that mobile technologies are shaping learning behaviours, and are an indicator of learning maturity, reflecting the wider context of societal enculturation.     

The simulated clinical environment: Cognitive and emotional impact among undergraduates

Context: Simulated clinical immersion (SCI) is used in undergraduate healthcare programs to expose the learner to real-life situations in authentic simulated clinical environments. For novices, the environment in which the simulation occurs can be distracting and stressful, hence potentially compromising learning.

Objectives: This study aims to determine whether SCI (with environment) imposes greater extraneous cognitive load and stress on undergraduate pharmacy students than simulated patients (SP) (without environment). It also aims to explore how features of the simulated environment influence students’ perception of learning.

Methods: In this mixed-methods study, 143 undergraduate pharmacy students experienced both SCI and SP in a crossover design. After the simulations, participants rated their cognitive load and emotions. Thirty-five students met in focus groups to explore their perception of learning in simulation.

Results: Intrinsic and extraneous cognitive load and stress scores in SCI were significantly but modestly higher compared to SP. Qualitative findings reveal that the physical environment in SCI generated more stress and affected students? focus. In SP, students concentrated on clinical reasoning. SCI stimulated a focus on data collection but impeded in-depth problem solving processes.

Conclusion: The physical environment in simulation influences what and how students learn. SCI was reported as more cognitively demanding than SP. Our findings emphasize the need for the development of adapted instructional design guidelines in simulation for novices.     

Do prerecorded lecture VODcasts affect lecture attendance of first-yearpre-clinical Graduate Entry to Medicine students?

Background: There is increasing concern amongst educators that the provision of recorded lectures may reduce student attendance of live lectures. We therefore sought to determine if the provision of prerecorded lecture video podcasts (VODcasts) to first-year Graduate Entry to Medicine (GEM) students, affected attendance at 21 Physiology lectures within three separate pre-clinical modules.

Methods: Data on lecture attendance, utilization of VODcasts, and whether VODcasts should replace live lectures were drawn from three surveys conducted in academic years 2014–2015 and 2015–2016 on all first-year GEM students in two first-year pre-clinical modules where prerecorded Physiology VODcasts were available for viewing or downloading prior to scheduled live lectures.

Results: A total of 191/214 (89%) students responded to the three surveys, with 84.3% of students attending all 21 lectures in the study. Only 4% of students missed more than one lecture in each of the three lecture series, with 79% indicating that VODcasts should not replace lectures.

Conclusion: Therefore, we conclude that the attendance of pre-clinical GEM students at live lectures is not significantly impacted upon by the provision of lecture VODcasts, with most students viewing them as useful revision tools rather than as a replacement for live lectures.     

Teaching the affective domain in community-based medical education: A scoping review

Abstract

Background: The affective domain is one of the essential areas in the assessment of the learning outcomes of medical students, apart from the cognitive and psychomotor domains. Community-based medical education (CBME) is a common instructional program for medical students in learning about these domains. However, preceptors and researchers pay less attention to the affective domain as compared to the other two learning domains.

Aim: To describe the state of the literature on teaching the affective domain through CBME and to develop an initial model for instructional purposes.

Methods: A scoping review of the literature was conducted. Out of the 971 references initially retrieved, 22 published references were selected. Relevant data from these references were extracted and analyzed through thematic analysis.

Results and Conclusion: The various affective outcomes of CBME in the literature are commonly taught through role modelling and mentoring, providing opportunity to apply knowledge, and immersing in local organizations and communities. However, these teaching strategies will be optimized through a structured and rigorous process of reflection. Reflection is central to the learning experience of medical students, especially that affective outcomes are commonly less apparent. The findings of this review resulted to a proposed initial model in teaching the affective domain in CBME.     

Reflecting on exchange students’ learning: Structure,objectives and supervision

Abstract

Background and aim: The increasing opportunities for medical students to participate in international electives may improve students’ professionalism and cultural competence. However, the students’ overall experiences may be unpredictable, unstructured and lack supervision. There is scant evidence with respect to their learning outcomes. These reflections demonstrate that short-term supervised elective can provide students with structured learning experiences to achieve specific learning objectives.

Methods: We carried out daily debriefs and a weekly summary with seven Curtin Medical School students from Perth, Australia during an 18-days supervised elective in the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. The daily debriefs and the weekly summary in different disciplines become the content of the reflections discussed in this article.

Results: The main themes identified in the feedback were as follows: Skills in history taking and physical examination; clinical reasoning; diagnosis and management of diseases rarely seen in Australia; awareness of clinical ethics; merits and demerits of different systems of healthcare; sensitivity to issues in doctor-patient relationships; work ethics; enhancement of cultural competence; and personal development.

Conclusions: These reflections provide insight into how overseas electives may be structured to improve students’ clinical reasoning skills in this hospital. These students achieved their learning outcomes under joint supervision from both institutions. The clinical skills learned from these experiences enhanced the students’ professionalism and cultural competence, giving students the opportunities to appreciate the multitude healthcare model of bio-psycho-social-political-economical-spiritual dimensions.     

iPad experience during clinical rotations from seven medical schools in the United States: Lessons learned

Background: Since 2010, many US medical schools have introduced the use of mobile technology into their curriculum. Preclinical use of mobile technologies has been well studied, but use in the clinical years has been less explored. Our objective was to identify the clinical uses and limitations of mobile technology in the clinical curriculum.

Methods: Interviews were conducted with key personnel at seven U. S. medical schools who introduced iPad programs during the clinical years. Interviews were qualitatively analyzed using a constant comparison technique.

Results and recommendations: Eight “best practices” for introducing mobile technology in the clinical years were identified: (1) plan before implementation, (2) define focused goals, (3) establish a tablet “culture,” (4) recruit appropriate implementation team, (5) invest in training, (6) involve students in mentoring, (7) accept variable use, and (8) encourage innovation.

Conclusions: There is growing interest in using mobile technology for teaching and learning in the clinical curriculum. Following the identified best practices may assist schools with the integration of the technology into the curriculum and better prepare medical students to handle the increasing use of technology.     

Cutoff score evaluation of undergraduate dental curriculum

Abstract

Background and objectives: Exams at the Faculty of Dentistry (KAUFD) are usually constructed to match King Abdulaziz University (KAU) policy of a fixed 60% cutoff score, though they have never been tested or evaluated. The purpose of this study was to validate the cutoff scores of three final fifth-year written exams of the undergraduate Endodontic course to assess whether they were similar to KAU regulation using the Angoff rating method.

Design and settings: This study was conducted between May 2014 and February 2015 at the Faculty of Dentistry, King Abdulaziz University.

Methods: Using the Angoff rating method, three final fifth-year undergraduate Endodontic written exams were evaluated by four senior faculty members.

Results: The cutoff scores for exams 1, 2 and 3 were 57.4%, 62.9% and 63.1%, respectively. Adjusting the exams’ cut off scores would cause changes in some students’ results.

Conclusions: Although the cutoff scores for all exams were close to 60%, slight deviation from the accepted cutoff score could definitely affect the students’ results. Therefore, all exams should be validated before being given to students to certify that the cutoff score is credible and defensible.     

How do formative objective structured clinical examinations drive learning? Analysis of residents’ perceptions

Introduction: Although several studies have explored the relationship between learning and written tests, little is understood about how performance-based examinations influence learning. The purpose of this study was to explore how a formative objective structured clinical examination (OSCE) drives learning.

Methods: We administered surveys to residents (n?=?35) at three time points to determine if and how an OSCE influenced their learning: before and immediately following the OSCE, and after the distribution of their results. Differences in quantitative responses between high- and low-performing residents and across time were compared using repeated-measures ANOVA. Thematic analysis was used to analyze narrative comments.

Results: Participants’ goals for the OSCE related to performance, mastery and feedback. Almost all participants reported that they had learned something from the OSCE (94%) and most participants generated learning goals after the OSCE (71%). High performers appeared to recognize the importance of content-related knowledge for scoring well before and after the OSCE, whereas low performers may have under-estimated its importance until after the examination.

Discussion: Participants viewed a formative OSCE as both a hurdle to overcome (assessment of learning) and an opportunity to learn (assessment for learning). Understanding how OSCEs influence study behavior can help guide the development of assessments that promote learning.     

How does peer teaching compare to faculty teaching? A systematic review and meta-analysis*

Purpose: In undergraduate medical education, peer-teaching has become an established and common method to enhance student learning. Evidence suggests that peer-teaching provides learning benefits for both learners and tutors. We aimed to describe the outcomes for medical students taught by peers through systematic review and meta-analysis of existing literature.

Methods: Seven databases were searched through 21 terms and their Boolean combinations. Studies reporting knowledge or skills outcomes of students taught by peers compared to those taught by faculty or qualified clinicians were included. Extracted data on students’ knowledge and skills outcomes were synthesised through a random effects model meta-analysis.

Results: The search yielded 2292 studies. Five hundred and fifty-three duplicates and 1611 irrelevant articles were removed during title-screening. The abstracts of 128 papers were screened against the inclusion and exclusion criteria. Ten studies have been included in the review. Meta-analyses showed no significant difference in peer-teaching compared to faculty teaching for knowledge or skills outcomes, standardised mean differences were 0.07 (95% CI: ?0.07, 0.21) and 0.11 (95% CI: ?0.07, 1.29), respectively.

Conclusion: Students taught by peers do not have significantly different outcomes to those taught by faculty. As the process of teaching helps to develop both tutor knowledge and teaching skills, peer-teaching should be supported.     

Medical College of the Future: from Informative to Transformative

Abstract

The complexity of medical education and healthcare systems is a ‘wicked problem’. Change will be a continuous iteration between evaluation and revaluation. Medicine is a social science. It is about people, societies and human interaction and communication. Medical College of the future should be developed in the light of social constructivism theories. Students from year one, day one, should be embedded in the work environment. Academic Healthcare Systems will be the norm not the exceptional. The training of students will be in all healthcare related facilities in the community. Public-private partnership in education and research will spread and become more regulated and encouraged. The students who want to be the future physicians should be selected differently. The curriculum will be more context related. Entrustable professional activities will be measured more frequently at different points of the students learning trajectory. Research and innovation will be integral to the students' learning experience. They should be exposed to how researchers think and behave and be embedded in a research environment. The medical college of the future will be using advanced technology which will be disruptive and transform existing educational models. E-Learning materials will be shared by consortia of collaborating medical colleges from all around the world. Artificial intelligence and machine learning will influence how students learn. National and international accreditation systems should ensure quality, but not stifle innovation. Physical learning spaces should reflect and express the underlying assumptions about “what is learning and teaching?”. This should be reflected and expressed through the design of its buildings, infrastructure, technology, furniture and out of class learning environment. Predicting the future is difficult in a rapidly changing world. Next generation physicians should be competent in treating the next generation of patients while maintaining the health of the population.