Comparison of computer-assisted instruction (CAI) versus traditional textbook methods for training in abdominal examination (Japanese experience)

Predominant aspects of knowledge and practical skills among medical students with online learning during the COVID-19 pandemic era

BACKGROUND

Social restrictions due to the COVID-19 pandemic have shifted most learning methods into online courses, especially for medical skills education. However, the effects of online courses on medical skill education amongst medical students are still arguable. The study aims to analyse medical students' knowledge, attitude, practice and satisfaction towards medical skills between online and offline courses.

METHOD

We performed a case-control study conducted among 533 medical students with online (as a case group, n = 288) and offline courses (as a control group, n = 245). We evaluated three fundamental medical skills, including history taking [HT], lung physical examination [LPE], and heart physical examination [HPE]. We tested the knowledge and skills among students through theory and practical examinations. Students' attitudes and satisfaction were assessed using a validated questionnaire.

RESULTS

The scores for knowledge and practical skills among the online group were significantly higher (p = 0.016, p = 0.004, respectively). In comparison, the scores for the students' attitudes and satisfaction were substantially lower (p = 0.000, p = 0.003, respectively) compared to the control group. Most of the students in both groups passed the exam (case vs. control = 81.94%; 83.27%, respectively). Males were the only factor associated with a higher rate of passing the examination (OR 0.42, 95% CI [0.27-0.67], p = 0.000).

CONCLUSIONS

Online learning could be an alternative approach on improving student's knowledge and practice towards medical skill especially amidst COVID-19 pandemic, however further consideration on student's attitude and satisfaction are mandatory to achieve appropriate competence as future general practitioner.

Evaluation of Virtual Reality High-Fidelity Adult Mannequin-based Simulation of Real-Life Clinical Scenarios in Teaching Clinical Pharmacology to Medical Students

Background

Presently, competency-based medical (CBME) curriculum challenges the medical educators to provide continuing education with new approaches to make learning more stimulating, motivating, and entertaining, fostering excellence in clinical practice. To address these issues, educators have advocated the use of virtual reality and mannequins to teach clinical pharmacology.

Aims and Objectives

To study the effect, perception, and feedback of virtual reality high-fidelity adult mannequin-based (VHFM) simulation of real-life clinical scenarios over conventional tutorials in teaching clinical pharmacology to medical students.

Material and Methods

An interventional study was designed for 2nd year MBBS students for a period of 6 months. The enrolled students were randomly assigned to the test group (VHFM) or control group (tutorials). The CAE Healthcare Ltd. maestro, high-fidelity prehospital mannequin (APOLLO) was used in the test group. Three sessions consisting of six different cases were discussed, and multiple-choice questions (MCQs)-based pre-test, post–test, and retest after a month were conducted in both groups and compared. The perception and feedback of faculty and students were obtained by using a modified and revalidated questionnaire.

Results

The test group outperformed the control group ( p <.001) in all sessions based on pre-test, post-test, and retest scores, and within-group comparisons revealed significant improvements in both groups. Students’ perceptions and feedback regarding VHFM were more enthusiastic and promising than in the tutorial group.

Conclusions

VHFM is student-centered, provides an active learning environment, and aids in skill development. We strongly suggest VHFM-based learning as a complement to traditional teaching strategies in pharmacology, especially for teaching clinical reasoning to medical students.

Determinants of Learning Anatomy in an Immersive Virtual Reality Environment - A Scoping Review

Given the decline of cadavers as anatomy teaching tools, immersive virtual reality (VR) technology has gained popularity as a potential alternative. To better understand how to maximize the educational potential of VR, this scoping review aimed to identify potential determinants of learning anatomy in an immersive VR environment. A literature search yielded 4523 studies, 25 of which were included after screening. Six common factors were derived from secondary outcomes in these papers: cognitive load, cybersickness, student perceptions, stereopsis, spatial understanding, and interactivity. Further objective research investigating the impact of these factors on anatomy examination performance is required.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01701-y.

Benefits of a bilingual web-based anatomy atlas for nursing students in learning anatomy

BACKGROUND

Registered nurses are required for high-quality healthcare. Thus, the anatomy course is essential regarding professional knowledge of the human body during the nursing training process. However, previous studies have indicated that anatomy teaching time and anatomy teachers were reduced and insufficient. Therefore, to improve the learning of practical anatomy in response to these difficulties, a bilingual National Taiwan University web-based anatomy atlas (NTU-WAA) was created as a cross-platform application and its feasibility was evaluated.

METHODS

The comparison of anatomy examination scores between nursing students of two cohorts (66 from the 2018-2019 cohort, whom was without NTU-WAA application; 54 from the 2019-2020 cohort, to whom NTU-WAA was offered) and the evaluation of questionnaires collected from nursing students of the 2019-2020 cohort and 4 anatomy teachers were carried out to define the feasibility of this strategy.

RESULTS

Results obtained by nursing students for the 2019-2020 cohort showed a significant increase in anatomy learning performance compared with that of the 2018-2019 cohort with reference to the laboratory midterm [2018-2019 cohort vs. 2019-2020 cohort, mean (standard deviation, SD): 77.20 (16.14) vs. 81.80 (12.03); p = 0.043], the laboratory final examination [59.68 (15.28) vs. 80.35 (13.74); p < 0.001] and the theory final examination [80.85 (10.10) vs. 84.33 (6.925); p = 0.017]. Moreover, results of the questionnaires indicated that the new bilingual cross-platform atlas was highly accepted by students and teachers.

CONCLUSIONS

The NTU-WAA, a bilingual web-based atlas, was evaluated as a beneficial anatomy-learning tool that may enhance self-study of nursing students with consequent amelioration of their anatomy-related performance in both theoretical and laboratory examinations. This reflection suggests the future implementation of the bilingual web-based atlas on a large scale.

Instructional Approaches: Anatomy Education of Physical Therapists

The profession of physical therapy has undergone an evolution since its inception. Since the early 1900s it has grown from a technical training program to a doctorate level degree. Human anatomy courses remain a requirement for physical therapist educational curricula. However, changes in anatomy pedagogy have been trending within health profession educational models, leading to questions regarding which method is best for student learning. The objective of this study was to determine if anatomy instructional method used within physical therapist educational curricula impacted current anatomy knowledge. Licensed physical therapists were recruited to complete a demographic survey and a questionnaire to demonstrate their knowledge of anatomy topics. Anatomy topics included six regional components: (1) upper limb; (2) lower limb; (3) thorax and abdomen; (4) pelvis; (5) spine; and (6) head. Each regional component contained five questions regarding systemic subsets related to joints and osteology, muscles, nervous system, vasculature, and special areas (e.g., spatial orientations, structures within spaces, pathways of nerves). Within the thorax and abdominal region, data analysis indicated that the dissection instruction method, when compared to no laboratory instruction, led to statistically significant greater anatomical knowledge (P = 0.02). Dissection also showed greater means when compared to the no laboratory method (P = 0.02) and the prosection method in the head region (P = 0.01). However, the variance explained by instructional method was small. This study adds empirical evidence regarding current anatomy knowledge exhibited by physical therapists as the level of anatomical knowledge exhibited small differences based on instructional methods.

Use Stereoscopic Model in Interventional and Surgical Procedures

The 3-dimensional (3D) stereoscopic modeling software allows anatomists to create high-resolution 3D models from computed tomography (CT) images. In this paper, we used high resolution CT images from a cadaver and a patient to develop clinically relevant anatomic models that can be used to teach surgical trainees different surgical procedures and approaches. The model facilitates visualization, manipulation, and interaction. It can be presented in stereoscopic 3D in a virtual environment, either in a classroom setting or immediately preceding a surgical procedure.

Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration

Background

Virtual patients are interactive digital simulations of clinical scenarios for the purpose of health professions education. There is no current collated evidence on the effectiveness of this form of education.

Objective

The goal of this study was to evaluate the effectiveness of virtual patients compared with traditional education, blended with traditional education, compared with other types of digital education, and design variants of virtual patients in health professions education. The outcomes of interest were knowledge, skills, attitudes, and satisfaction.

Methods

We performed a systematic review on the effectiveness of virtual patient simulations in pre- and postregistration health professions education following Cochrane methodology. We searched 7 databases from the year 1990 up to September 2018. No language restrictions were applied. We included randomized controlled trials and cluster randomized trials. We independently selected studies, extracted data, and assessed risk of bias and then compared the information in pairs. We contacted study authors for additional information if necessary. All pooled analyses were based on random-effects models.

Results

A total of 51 trials involving 4696 participants met our inclusion criteria. Furthermore, 25 studies compared virtual patients with traditional education, 11 studies investigated virtual patients as blended learning, 5 studies compared virtual patients with different forms of digital education, and 10 studies compared different design variants. The pooled analysis of studies comparing the effect of virtual patients to traditional education showed similar results for knowledge (standardized mean difference [SMD]=0.11, 95% CI −0.17 to 0.39, I²=74%, n=927) and favored virtual patients for skills (SMD=0.90, 95% CI 0.49 to 1.32, I²=88%, n=897). Studies measuring attitudes and satisfaction predominantly used surveys with item-by-item comparison. Trials comparing virtual patients with different forms of digital education and design variants were not numerous enough to give clear recommendations. Several methodological limitations in the included studies and heterogeneity contributed to a generally low quality of evidence.

Conclusions

Low to modest and mixed evidence suggests that when compared with traditional education, virtual patients can more effectively improve skills, and at least as effectively improve knowledge. The skills that improved were clinical reasoning, procedural skills, and a mix of procedural and team skills. We found evidence of effectiveness in both high-income and low- and middle-income countries, demonstrating the global applicability of virtual patients. Further research should explore the utility of different design variants of virtual patients.

Examining the Efficacy of Online Self-Paced Interactive Video-Recordings in Nursing Skill Competency Learning: Seeking Preliminary Evidence Through an Action Research

A key challenge in nursing education is how to teach the students clinical competencies effectively and to provide opportunities for practicing the fundamental nursing skills safely. The purpose of this study was to examine the competency scores of practicing a clinical skill and the satisfaction level of nursing students on three instructional methods using an action research: the online self-paced interactive video learning, demonstration-only method, and a video demonstration in class. Participants were both male and female nursing students enrolled in the Foundations of Nursing Course (N = 26, 6 males and 20 females; mean age = 19.42 ± 0.50) and were evaluated at precycle, postcycle 1, and postcycle 2. Each cycle of inquiry was planned to address the problems quickly and efficiently through four steps: planning, acting, observing, and reflecting. A triangulation technique was employed for data collection using a competency skill evaluation checklist, a satisfaction questionnaire, and a focus group feedback questionnaire. A video was developed in the researcher's college pertaining to the practical skills. Each research cycle was successively built up on one another using the reflections and feedback from the students based on the previous cycle. The competency skills at various cycles did not demonstrate significant differences between three instructional methods, whereas satisfaction score was the highest with the online self-paced interactive video demonstration. Online video learning use as a supplement in nursing instruction is well supported and offers a promising alternative in teaching clinical skill compared with other teaching strategies. However, more rigorous studies are required to get further empirical evidence in replacing the demonstration method, for teaching nursing practical skill and in improving students' learning ability and competence.

Computer Assisted Learning: Assessment of the Veterinary Virtual Anatomy Education Software IVALA™

Although cadaveric dissection has historically been the cornerstone of anatomical education, it comes at the cost of some emotional, moral, safety, and environmental concerns. Computer assisted learning (CAL) programs are an increasingly common solution to these issues; however, research regarding the efficacy of high fidelity simulation is limited. The traditional first semester veterinary gross anatomy course curriculum at Ross University School of Veterinary Medicine (RUSVM) was supplemented with a web based virtual anatomy program, IVALA™ (www.ivalalearn.com). The purpose of this study was to assess the relationship between supplementary use of the IVALA™ program and student examination scores, and to measure student perception surrounding IVALA™. IVALA™ uses an interactive virtual canine specimen that enables students to identify, move, rotate, magnify, and remove individual anatomic structures while providing a text description of each selected anatomic point. Fifty-six first semester RUSVM students who supplemented their anatomic learning with the IVALA™ program performed significantly higher on examinations compared to students (n = 123) that did not (p = 0.003). Students’ overall perception toward IVALA™ was enjoyable (mean = 3.8 out of a 5-point Likert scale) and beneficial to their knowledge of anatomy (mean = 3.7); however, students did not support replacing cadaveric dissection with CAL (mean = 2.1). CAL can effectively supplement learning outcomes for veterinary anatomy.

The skeletons in our closet: E-learning tools and what happens when one side does not fit all

In the anatomical sciences, e-learning tools have become a critical component of teaching anatomy when physical space and cadaveric resources are limited. However, studies that use empirical evidence to compare their efficacy to visual-kinesthetic learning modalities are scarce. The study examined how a visual-kinesthetic experience, involving a physical skeleton, impacts learning when compared with virtual manipulation of a simple two-dimensional (2D) e-learning tool, A.D.A.M. Interactive Anatomy. Students from The University of Western Ontario, Canada (n = 77) participated in a dual-task study to: (1) investigate if a dual-task paradigm is an effective tool for measuring cognitive load across these different learning modalities; and (2) to assess the impact of knowledge recall and spatial ability when using them. Students were assessed using knowledge scores, Stroop task reaction times, and mental rotation test scores. Results demonstrated that the dual-task paradigm was not an effective tool for measuring cognitive load across different learning modalities with respect to kinesthetic learning. However, our study highlighted that handing physical specimens yielded major, positive impacts on performance that a simple commercial e-learning tool failed to deliver (P < 0.001). Furthermore, students with low spatial ability were significantly disadvantaged when they studied the bony joint and were tested on contralateral images (P = 0.046, R = 0.326). This suggests that, despite limbs being mirror images, students should be taught the anatomy of, as well as procedures on, both sides of the human body, enhancing the ability of all students, regardless of spatial ability, to take anatomical knowledge into the clinic and perform successfully. Anat Sci Educ 10: 570-588. © 2017 American Association of Anatomists.

Visualization of stereoscopic anatomic models of the paranasal sinuses and cervical vertebrae from the surgical and procedural perspective

Recent improvements in three-dimensional (3D) virtual modeling software allows anatomists to generate high-resolution, visually appealing, colored, anatomical 3D models from computed tomography (CT) images. In this study, high-resolution CT images of a cadaver were used to develop clinically relevant anatomic models including facial skull, nasal cavity, septum, turbinates, paranasal sinuses, optic nerve, pituitary gland, carotid artery, cervical vertebrae, atlanto-axial joint, cervical spinal cord, cervical nerve root, and vertebral artery that can be used to teach clinical trainees (students, residents, and fellows) approaches for trans-sphenoidal pituitary surgery and cervical spine injection procedure. Volume, surface rendering and a new rendering technique, semi-auto-combined, were applied in the study. These models enable visualization, manipulation, and interaction on a computer and can be presented in a stereoscopic 3D virtual environment, which makes users feel as if they are inside the model. Anat Sci Educ 10: 598-606. © 2017 American Association of Anatomists.

Effective methods of teaching and learning in anatomy as a basic science: A BEME systematic review: BEME guide no. 44

BACKGROUND

Anatomy is a subject essential to medical practice, yet time committed to teaching is on the decline, and resources required to teach anatomy is costly, particularly dissection. Advances in technology are a potential solution to the problem, while maintaining the quality of teaching required for eventual clinical application.

AIM

To identify methods used to teach anatomy, including those demonstrated to enhance knowledge acquisition and retention.

METHODS

PubMed, CINAHL, ERIC, Academic OneFile, ProQuest, SAGE journals and Scopus were search from the earliest entry of each database to 31 August 2015. All included articles were assessed for methodological quality and low quality articles were excluded from the study. Studies were evaluated by assessment scores, qualitative outcomes where included as well as a modified Kirkpatrick model.

RESULTS

A total of 17,820 articles were initially identified, with 29 included in the review. The review found a wide variety of teaching interventions represented in the range of studies, with CAI/CAL studies predominating in terms of teaching interventions, followed by simulation. In addition to this, CAI/CAL and simulation studies demonstrated better results overall compared to traditional teaching methods and there is evidence to support CAI/CAL as a partial replacement for dissection or a valuable tool in conjunction with dissection.

CONCLUSIONS

This review provides evidence in support of the use of alternatives to traditional teaching methods in anatomy, in particular, the use of CAI/CAL with a number of high quality, low risk of bias studies supporting this.

Evaluation of the effectiveness of 3D vascular stereoscopic models in anatomy instruction for first year medical students

The head and neck region is one of the most complex areas featured in the medical gross anatomy curriculum. The effectiveness of using three-dimensional (3D) models to teach anatomy is a topic of much discussion in medical education research. However, the use of 3D stereoscopic models of the head and neck circulation in anatomy education has not been previously studied in detail. This study investigated whether 3D stereoscopic models created from computed tomographic angiography (CTA) data were efficacious teaching tools for the head and neck vascular anatomy. The test subjects were first year medical students at the University of Mississippi Medical Center. The assessment tools included: anatomy knowledge tests (prelearning session knowledge test and postlearning session knowledge test), mental rotation tests (spatial ability; presession MRT and postsession MRT), and a satisfaction survey. Results were analyzed using a Wilcoxon rank-sum test and linear regression analysis. A total of 39 first year medical students participated in the study. The results indicated that all students who were exposed to the stereoscopic 3D vascular models in 3D learning sessions increased their ability to correctly identify the head and neck vascular anatomy. Most importantly, for students with low-spatial ability, 3D learning sessions improved postsession knowledge scores to a level comparable to that demonstrated by students with high-spatial ability indicating that the use of 3D stereoscopic models may be particularly valuable to these students with low-spatial ability. Anat Sci Educ 10: 34-45. © 2016 American Association of Anatomists.

The Effectiveness of Computer-Assisted Instruction to Teach Physical Examination to Students and Trainees in the Health Sciences Professions: A Systematic Review and Meta-Analysis

PURPOSE

To explore knowledge and skill acquisition outcomes related to learning physical examination (PE) through computer-assisted instruction (CAI) compared with a face-to-face (F2F) approach.

METHOD

A systematic literature review and meta-analysis published between January 2001 and December 2016 was conducted. Databases searched included Medline, Cochrane, CINAHL, ERIC, Ebsco, Scopus, and Web of Science. Studies were synthesized by study design, intervention, and outcomes. Statistical analyses included DerSimonian-Laird random-effects model.

RESULTS

In total, 7 studies were included in the review, and 5 in the meta-analysis. There were no statistically significant differences for knowledge (mean difference [MD] = 5.39, 95% confidence interval [CI]: -2.05 to 12.84) or skill acquisition (MD = 0.35, 95% CI: -5.30 to 6.01).

CONCLUSIONS

The evidence does not suggest a strong consistent preference for either CAI or F2F instruction to teach students/trainees PE. Further research is needed to identify conditions which examine knowledge and skill acquisition outcomes that favor one mode of instruction over the other.

The development of a virtual 3D model of the renal corpuscle from serial histological sections for E-learning environments

Histology is a core subject in the anatomical sciences where learners are challenged to interpret two-dimensional (2D) information (gained from histological sections) to extrapolate and understand the three-dimensional (3D) morphology of cells, tissues, and organs. In gross anatomical education 3D models and learning tools have been associated with improved learning outcomes, but similar tools have not been created for histology education to visualize complex cellular structure-function relationships. This study outlines steps in creating a virtual 3D model of the renal corpuscle from serial, semi-thin, histological sections obtained from epoxy resin-embedded kidney tissue. The virtual renal corpuscle model was generated by digital segmentation to identify: Bowman's capsule, nuclei of epithelial cells in the parietal capsule, afferent arteriole, efferent arteriole, proximal convoluted tubule, distal convoluted tubule, glomerular capillaries, podocyte nuclei, nuclei of extraglomerular mesangial cells, nuclei of epithelial cells of the macula densa in the distal convoluted tubule. In addition to the imported images of the original sections the software generates, and allows for visualization of, images of virtual sections generated in any desired orientation, thus serving as a "virtual microtome". These sections can be viewed separately or with the 3D model in transparency. This approach allows for the development of interactive e-learning tools designed to enhance histology education of microscopic structures with complex cellular interrelationships. Future studies will focus on testing the efficacy of interactive virtual 3D models for histology education.

Offline eLearning for undergraduates in health professions: A systematic review of the impact on knowledge, skills, attitudes and satisfaction

BACKGROUND

The world is short of 7.2 million health-care workers and this figure is growing. The shortage of teachers is even greater, which limits traditional education modes. eLearning may help overcome this training need. Offline eLearning is useful in remote and resource-limited settings with poor internet access. To inform investments in offline eLearning, we need to establish its effectiveness in terms of gaining knowledge and skills, students' satisfaction and attitudes towards eLearning.

METHODS

We conducted a systematic review of offline eLearning for students enrolled in undergraduate, health-related university degrees. We included randomised controlled trials that compared offline eLearning to traditional learning or an alternative eLearning method. We searched the major bibliographic databases in August 2013 to identify articles that focused primarily on students' knowledge, skills, satisfaction and attitudes toward eLearning, and health economic information and adverse effects as secondary outcomes. We also searched reference lists of relevant studies. Two reviewers independently extracted data from the included studies. We synthesized the findings using a thematic summary approach.

FINDINGS

Forty-nine studies, including 4955 students enrolled in undergraduate medical, dentistry, nursing, psychology, or physical therapy studies, met the inclusion criteria. Eleven of the 33 studies testing knowledge gains found significantly higher gains in the eLearning intervention groups compared to traditional learning, whereas 21 did not detect significant differences or found mixed results. One study did not test for differences. Eight studies detected significantly higher skill gains in the eLearning intervention groups, whilst the other 5 testing skill gains did not detect differences between groups. No study found offline eLearning as inferior. Generally no differences in attitudes or preference of eLearning over traditional learning were observed. No clear trends were found in the comparison of different modes of eLearning. Most of the studies were small and subject to several biases.

CONCLUSIONS

Our results suggest that offline eLearning is equivalent and possibly superior to traditional learning regarding knowledge, skills, attitudes and satisfaction. Although a robust conclusion cannot be drawn due to variable quality of the evidence, these results justify further investment into offline eLearning to address the global health care workforce shortage.

British Columbia interprofessional model for simulation-based education in health care: a network of simulation sites

The rapid uptake of simulation-based education has led to the development of simulation programs and centers all around the world. Unfortunately, many of these centers are functioning as localized silos and not taking advantage of the potential for collaboration with other regional centers to promote interprofessional education. In the province of British Columbia (BC), Canada, 38 institutions, including health care authorities, universities, colleges, and other health-related organizations, have participated in assessing the use of simulation in BC and in developing a provincial model that enables collaboration and interprofessional learning at the provincial level.This article describes methods and results of a needs assessment and discusses an interprofessional simulation in health care educational model that provides access for all health care professionals in BC regardless of their geographic location and/or institutional affiliation. We anticipate that this information will be useful to and supportive of others in developing simulation collaborations in their respective regions.

Exploring the changing learning environment of the gross anatomy lab

PURPOSE

The objective of this study was to assess the impact of virtual models and prosected specimens in the context of the gross anatomy lab.

METHOD

In 2009, student volunteers from an undergraduate anatomy class were randomly assigned to study groups in one of three learning conditions. All groups studied the muscles of mastication and completed identical learning objectives during a 45-minute lab. All groups were provided with two reference atlases. Groups were distinguished by the type of primary tools they were provided: gross prosections, three-dimensional stereoscopic computer model, or both resources. The facilitator kept observational field notes. A prepost multiple-choice knowledge test was administered to evaluate students' learning.

RESULTS

No significant effect of the laboratory models was demonstrated between groups on the prepost assessment of knowledge. Recurring observations included students' tendency to revert to individual memorization prior to the posttest, rotation of models to match views in the provided atlas, and dissemination of groups into smaller working units.

CONCLUSIONS

The use of virtual lab resources seemed to influence the social context and learning environment of the anatomy lab. As computer-based learning methods are implemented and studied, they must be evaluated beyond their impact on knowledge gain to consider the effect technology has on students' social development.

Virtual reality anatomy: is it comparable with traditional methods in the teaching of human forearm musculoskeletal anatomy?

The use of cadavers to teach anatomy is well established, but limitations with this approach have led to the introduction of alternative teaching methods. One such method is the use of three-dimensional virtual reality computer models. An interactive, three-dimensional computer model of human forearm anterior compartment musculoskeletal anatomy was produced using the open source 3D imaging program "Blender." The aim was to evaluate the use of 3D virtual reality when compared with traditional anatomy teaching methods. Three groups were identified from the University of Manchester second year Human Anatomy Research Skills Module class: a "control" group (no prior knowledge of forearm anatomy), a "traditional methods" group (taught using dissection and textbooks), and a "model" group (taught solely using e-resource). The groups were assessed on anatomy of the forearm by a ten question practical examination. ANOVA analysis showed the model group mean test score to be significantly higher than the control group (mean 7.25 vs. 1.46, P < 0.001) and not significantly different to the traditional methods group (mean 6.87, P > 0.5). Feedback from all users of the e-resource was positive. Virtual reality anatomy learning can be used to compliment traditional teaching methods effectively.

Comparison of traditional and interactive teaching methods in a UK emergency department

Didactic teaching remains a core component of undergraduate education, but developing computer assisted learning (CAL) packages may provide useful alternatives. We compared the effectiveness of interactive multimedia-based tutorials with traditional, lecture-based models for teaching arterial blood gas interpretation to fourth year medical students. Participants were randomized to complete a tutorial in either lecture or multimedia format containing identical content. Upon completion, students answered five multiple choice questions assessing post-tutorial knowledge, and provided feedback on their allocated learning method. Marks revealed no significant difference between either group. All lecture candidates rated their teaching as good, compared with 89% of the CAL group. All CAL users found multiple choice questions assessment useful, compared with 83% of lecture participants. Both groups highlighted the importance of interaction. CAL complements other teaching methods, but should be seen as an adjunct to, rather than a replacement for, traditional methods, thus offering students a blended learning environment.

Centre of Excellence For Simulation Education and Innovation (CESEI)

Simulation is becoming an integral part of medical education. The American College of Surgeons (ACS) was the first organization to recognize the value of simulation-based learning, and to award accreditation for educational institutions that aim to provide simulation as part of the experiential learning opportunity. Centre of Excellence for Simulation Education and Innovation (CESEI) is a multidisciplinary and interprofessional educational facility that is based at the University of British Columbia (UBC) and Vancouver Costal Health Authority (VCH). Centre of Excellence for Simulation Education and Innovation's goal is to provide excellence in education, research, and healthcare delivery by providing a technologically advanced environment and learning opportunity using simulation for various groups of learners including undergraduate, postgraduate, nursing, and allied health professionals. This article is an attempt to describe the infrastructure, services, and uniqueness of the Centre of Excellence for Simulation Education and Innovation.

Introduction of e-learning in dental radiology reveals significantly improved results in final examination

PURPOSE

Because a traditionally instructed dental radiology lecture course is very time-consuming and labour-intensive, online courseware, including an interactive-learning module, was implemented to support the lectures. The purpose of this study was to evaluate the perceptions of students who have worked with web-based courseware as well as the effect on their results in final examinations.

MATERIALS AND METHODS

Users (n(3+4)=138) had access to the e-program from any networked computer at any time. Two groups (n(3)=71, n(4)=67) had to pass a final exam after using the e-course. Results were compared with two groups (n(1)=42, n(2)=48) who had studied the same content by attending traditional lectures. In addition a survey of the students was statistically evaluated.

RESULTS

Most of the respondents reported a positive attitude towards e-learning and would have appreciated more access to computer-assisted instruction. Two years after initiating the e-course the failure rate in the final examination dropped significantly, from 40% to less than 2%.

CONCLUSIONS

The very positive response to the e-program and improved test scores demonstrated the effectiveness of our e-course as a learning aid. Interactive modules in step with clinical practice provided learning that is not achieved by traditional teaching methods alone. To what extent staff savings are possible is part of a further study.

Effectiveness of an online curriculum for medical students on genetics, genetic testing and counseling

BACKGROUND

It is increasingly important that physicians have a thorough understanding of the basic science of human genetics and the ethical, legal and social implications (ELSI) associated with genetic testing and counseling.

METHODS

The authors developed a series of web-based courses for medical students on these topics. The course modules are interactive, emphasize clinical case studies, and can easily be incorporated into existing medical school curricula.

RESULTS

Results of a 'real world' effectiveness trial indicate that the courses have a statistically significant effect on knowledge, attitude, intended behavior and self-efficacy related to genetic testing (p<0.001; N varies between 163 and 596 for each course).

CONCLUSIONS

The results indicate that this curriculum is an effective tool for educating medical students on the ELSI associated with genetic testing and for promoting positive changes in students' confidence, counseling attitudes and behaviors.

Computer-based learning versus practical course in pre-clinical education: acceptance and knowledge retention

BACKGROUND

Computer-based learning is a tool that, when designed appropriately, can be used to effectively meet worthy educational goals.

AIMS

This study aimed to compare acceptance and effectiveness of a tutored computer-based practical course (CPC) with a traditional biochemical laboratory experiment in pre-clinical medical education.

METHOD

Under quasi-randomised conditions two cohorts of second-year medical students performed either a CPC or a laboratory experiment. Students' perceptions were obtained by assessment questionnaires, knowledge retention was investigated by post test.

RESULTS

The students evaluated the CPC highly significantly better than the laboratory experiment. Students performing the CPC demonstrated a statistically significant greater knowledge retention compared to students who performed the laboratory experiment.

CONCLUSIONS

These findings show that learning objectives concerning basic biochemical knowledge can be acquired in a CPC and that medical students accept such a CPC as a substitute for a real laboratory experiment.

Evaluation of a computer program ('disect') to consolidate anatomy knowledge: a randomised-controlled trial

BACKGROUND

The teaching of anatomy to medical undergraduates continues to develop. Medical imaging can accurately demonstrate anatomy. 'disect' is a computer program which manipulates and reconstructs real CT images in 3-D.

AIM

To implement and assess a novel computer-based imaging resource.

METHODS

Third-year undergraduate medical students at the University of East Anglia were randomised to different methods of delivering the program - either self-directed use or guided use with worksheets. Knowledge of gastro-intestinal anatomy was assessed using a 20-item test. Attitudes to using 'disect' were evaluated using Likert scales.

RESULTS

Most students reported the program was easy to use and a valuable resource for learning anatomy. There was no difference in scores between guided use and self-directed use (10.7 marks versus 10.6 marks, p = 0.52). Students who undertook the anatomy special study module, which involved dissection of the digestive system, performed best (12.8 marks versus 9.9 marks, p = 0.005).

CONCLUSION

Students can adequately use a computer program to see major anatomical structures derived from CT scans. Students reported that learning anatomy can be aided by the imaging-based resource. Learning anatomy is a multi-modal activity and packages like 'disect' can enhance learning by supplementing current teaching methods.

Is learning anatomy facilitated by computer-aided learning? A review of the literature

BACKGROUND

There is ongoing debate concerning the best way to teach anatomy. Computer-assisted learning (CAL) is one option for teaching anatomy and these resources are increasingly available.

AIMS

To assess the use of such resources in undergraduate medical student anatomy tuition.

METHOD

Literature review.

RESULTS

Eight quantitative studies were found and these tended to report favourably. Though these educational packages can show improvement in knowledge, the studies tended to cover small areas of anatomy or were assessed in short courses. There were also several assessments of learner's attitudes to CAL which tended to report favourably in terms of educational satisfaction and enjoyment.

CONCLUSIONS

There is insufficient evidence to show that these resources have a true place for replacing traditional methods in teaching anatomy. Further research should be conducted to determine how to use these resources in conjunction with current teaching methods or how their use can be integrated into the current anatomy curriculum.

Evaluation of different delivery modes of an interactive e-learning programme for teaching cultural diversity

OBJECTIVE

UK medical schools find it challenging to provide standardised teaching to expanding year intakes. In addition, developing and implementing diversity training can cause difficulties. This paper describes the evaluation of an interactive e-learning programme to raise awareness and understanding of communication difficulties in diversity consultations.

METHODS

The programme was part of an undergraduate portfolio-based community module. Three hundred and two students were assigned to one of three delivery methods--a large group setting, small groups with a facilitator, and as part of distance learning while on community placement. The evaluation included analysis of their coursework marks, a self-completed evaluation questionnaire, and small group discussions.

RESULTS

Two hundred and twenty-three students took part in the evaluation. They were able to apply the concepts they learnt to clinical examples from their own experiences. Type of delivery did not affect coursework marks, but students tended to prefer the e-learning as part of a distance learning package. They offered helpful suggestions to improve its complexity and range.

CONCLUSION

The acceptability and utility of this e-learning module both in face to face teaching and remote placement has been demonstrated, and evaluation by the students has provided valuable information for its further development.

PRACTICE IMPLICATIONS

All medical schools should include some diversity training, and further research should concentrate on the effects of this type of learning on longer term outcomes such as attitude and performance tests. Such tools could reduce demands on staff time in facilitation of small groupwork, and their cost effectiveness could be increased by making them available to other medical schools.

Testing the satisfaction and feasibility of a computer-based teaching module in the neonatal intensive care unit

PURPOSE

To examine the satisfaction with and feasibility of a computer-based teaching module to teach healthcare professionals how to use and apply the Premature Infant Pain Profile (PIPP) to clinical scenarios.

SUBJECTS

Sixty-eight healthcare professionals who were employed in the neonatal intensive care unit (NICU) on a full-time or part-time basis and had received an educational session regarding the PIPP.

DESIGN AND METHODS

A pilot study using an exploratory descriptive design was used to answer: (1) How satisfied are healthcare professionals with the computer-based teaching module? and (2) What is the feasibility of a computer-based teaching module in the clinical setting? Satisfaction was measured using an investigator-developed 5-point Likert scale. Feasibility was measured in terms of time to complete the module, satisfaction with instructions and ability to navigate through the module, acceptability of the module as a teaching method, and format with the computer-based module.

PRINCIPAL RESULTS

Ninety percent of those sampled were very satisfied with the computer-based teaching method. Use of video and audio clips and photographs enhanced the learning process. Healthcare professionals identified the computer-based teaching method as an effective way of learning about the PIPP and thought that it was feasible to use within the clinical setting.

CONCLUSIONS

Computer-based teaching is a feasible method for educating NICU healthcare professionals about the PIPP. Additional research is required to examine the effectiveness of this teaching method on relevant patient outcomes such as pain management.

Centers of excellence: a new dimension in surgical education

Surgical education has always been challenging and is being made more difficult with the changes in the surgical environment. In the past decade, the number of patients available for educational purposes has decreased because of the development of technology that has significantly reduced their time of stay in the hospital and has also moved many surgical procedures to ambulatory services. Technologic advances also create the demand for more specialized training. The increased number of undergraduate, postgraduate students, and clinical fellows has also affected the educational mandate of the academic hospitals. Alternative ways to teach medicine, and especially surgery, are becoming inevitable. One such method is to teach students outside the operating room in a simulated environment. This article reports on the developments of surgical education centers and provides guidance for those who might wish to develop such educational facilities. For further information, visit www.cesei.org.

Redefining classroom instruction

In this study, the role of the classroom instructor was redefined from a "lecturer" responsible for delivering the core curriculum to a "facilitator" at the center of an active learning environment. Web-based lectures were used to provide foundation content to students outside of the classroom, which made it possible to improve the quality of student-faculty contact time in the classroom. Students reported that this hybrid format of instruction afforded them a better understanding of the content, a higher probability of retaining the content, and the opportunity to spend more time thinking about the application of the content compared with more traditional lecture-based methods of instruction.

Design and implementation of a web-based, database-driven histology atlas: Technology at work

At Vanderbilt University, the "Human Cell and Tissue Biology" course is a required lecture and laboratory course with 2 full-time instructors and 106 students. To address demands placed on faculty for individual attention, an interactive Web-based histology atlas was developed and implemented in January 2005. This atlas was specifically designed to complement the existing laboratory manual and to transform the manual into an interactive educational tool whereby students could view high-resolution images of histological specimens online. By utilizing a computer scripting language, interactive highlighting of histological structures was accomplished through the implementation of a simple mouse-rollover function. This computer-aided instruction software allows students to preview histological structures of interest prior to entering the laboratory, to have additional faculty-directed contact hours during laboratory, and to review material efficiently. The conversion of the originally developed static application into a database-driven tool streamlined the development and modification of the atlas while facilitating the creation of advanced features. Six weeks after launching this interactive atlas, Vanderbilt medical students logged 1,200 hr of use. Through the cooperative efforts of faculty and students, the interactive atlas evolved to meet the educational demands of medical students owing to the development and implementation of a database structure. The functionality and educational value of the interactive atlas in facilitating self-learning was ultimately measured by positive student feedback and use.

Perspectives in Medical Education

A blueprint for reform of medical education in Japan is presented, with the goal of training well rounded physicians who possess the ability to think critically and the clinical skill to function as generalists before they enter specialty training. Practical solutions are offered in three problem areas that lie at the heart of the shortcomings in Japanese medical education. They have to do with (i) the way Japanese students learn, (ii) the way Japanese teachers teach, and (iii) the material that students are taught. The inherently passive nature of Japanese students can be changed by emphasizing "active learning" and "critical thinking at the bedside" through a problem-oriented approach, both in the classroom and in the wards. Changing student learning, however, requires a commitment to teaching. At the present time, there is no incentive to teach at all, let alone teach in a constructive or interactive way. Teaching is widely perceived as a burden that takes time away from research, rather than as a credible and rewarding academic pursuit. Thus, promotion policies must be altered to reward teachers and accord teaching its rightful place as a primary function of the faculty. Finally, the introduction of active learning and interactive teaching depends on reducing the current emphasis on didactic instruction, which is passive and unidirectional. Thus, medical school curricula must be restructured to emphasize a problem-oriented, organ system-based approach throughout medical school, starting from the preclinical years. Reforms in all three areas must be implemented in concert for them to succeed.

An electronic instructor for gross anatomy dissection

Gross anatomy is time consuming to teach and to learn. Because the process of dissection takes up so much student time, assistance in the form of an in-lab instructional DVD program might improve student performance. The DVD could be viewed with a portable device by individual dissection groups at their tables. Groups could dissect at their own pace, with access to step-by-step demonstrations and answers to frequently asked anatomical questions. We created an instructional DVD program demonstrating dissection of the canine ventral neck and thoracic limb. The effect on student exam scores of using the DVD versus not using it was measured in a controlled, two-sample study using incoming first-year veterinary students as volunteers. Volunteers were told the study was of two different dissection methods; the DVD was not specifically mentioned until after the students were separated into two groups (Blue/DVD group and Orange/No DVD group), and then only to volunteers in the Blue group. Except for the DVD, the two groups had the same resources. The difference in scores on an exam given after a single dissection period did not differ sufficiently to conclude that DVD use raised the mean score; however, 73% of the DVD group scored 60% or higher, while only 38% of the No DVD group scored 60% or higher. The difference in mean scores overall was 2.3 points out of a possible 49, suggesting that the DVD helped students, especially those with lower scores, to earn two to three more points than they would have otherwise.

[Computer-based training in dermatooncology--a preliminary report comparing electronic learning programs with face-to-face teaching]

BACKGROUND

Electronic media are increasingly used in medical education. The question arises whether tutorial programs are as effective as innovative face-to-face didactic formats.

METHODS

26 students underwent a special dermatooncology course in an integrated undergraduate medical curriculum. One part of the content was acquired face-to-face with emphasis on team learning and mini-lectures; the other part was presented as web-based electronic computer-based training objects. The performance of the students in a subsequent multiple choice test was evaluated.

RESULTS

In total, questions referring to computer-based training contents were answered correctly in 90.4 +/- 12.5 %, which was significantly superior to the questions referring to team learning in the face-to-face teaching format (80.6 +/- 13.1 %; p < 0.001). There was, however, a significant correlation between both results for each individual student (r = 0.52; p < 0.01), but there was no correlation between the results obtained for computer-based training or team learning on the one hand, and the overall performance of the individual student on the other.

CONCLUSIONS

Though different contents were concerned, our study provides evidence that computer-based training may be more efficient than face-to-face teaching using team learning to communicate dermatooncology contents in an undergraduate medical curriculum.