An e-learning reproductive health module to support improved student learning and interaction: a prospective interventional study at a medical school in Egypt

A novel approach to improving colonoscopy learning efficiency through a colonoscope roaming system: randomized controlled trial

Background

Colonoscopy is indispensable in the diagnosis and treatment of lower digestive tract (LDT) diseases. Skilled colonoscopists are in great demand, but it takes considerable time for beginners to become experts. In addition, patients may refuse to permit primary learners to practise colonoscopy on them. Thus, improving the instructional programmes and models for primary learners is a key issue in endoscopy training. Convenience and a self-paced, learner-centred approach make e-learning an excellent instructional prospect. Therefore, we created the Colonoscope Roaming System (CRS) to assist in colonoscopy teaching procedures. We aimed to develop the e-learning software, test it with beginner colonoscopists and evaluate its effectiveness via subjective and objective methods.

Methods

Through a randomized controlled trial, participants were randomly allocated to an e-learning group (EG) or a control group (CG) after a pretest evaluation. The CG learned through the traditional colonoscopy teaching mode, while the EG used CRS in addition to the traditional teaching mode. Subsequent to the training, the participants completed a posttest and colonoscopy examination. The EG also completed a satisfaction questionnaire.

Results

Of the 84 participants, 81 (96%) finished the colonoscopy learning and evaluation modules of the CRS. No conspicuous differences in the pretest scores were found between the EG and CG (p > 0.05). Two months later, the posttest scores for the EG were higher than those of the CG (p < 0.001), and the EG had better performance on the colonoscopy examination (p < 0.01). Overall, 86.25% of questions raised in Q1-Q20 were satisfied with the CRS and considered it successful.

Conclusions

The use of CRS may be an effective approach to educate beginner colonoscopists to attain skills.

PRIME Immunology: Self-directed Introduction to Medical School Immunology

INTRODUCTION

Medical students find immunology difficult to understand and relate to clinically and are often frustrated by the amount of detailed material. We created PRIME Immunology: Preview or Review of Important Material for Everyone: (i) video modules, (ii) Instagram site, and (iii) vocabulary files called Immunology Language.

METHODS

The self-paced modules introduced key topics in immunology for students to complete prior to their instructional block.

RESULTS AND CONCLUSIONS

Use of PRIME Immunology during a 3-year period suggested that providing students with an overview of key topics before the start of their course may (i) reduce student angst about immunology and (ii) improve retention of immunology.

Evaluation of global health capacity building initiatives in low-and middle-income countries: A systematic review

BACKGROUND

Low- and middle-income countries (LMICs) are in dire need to improve their health outcomes. Although Global Health Capacity Building (GHCB) initiatives are recommended approaches, they risk being ineffective in the absence of standardized evaluation methods. This study systematically reviews evaluation approaches for GHCB initiatives in LMICs.

METHODS

We searched the Medline (OVID), PubMed, Scopus, and Embase.com databases for studies reporting evaluation of a GHCB initiative in a LMIC from January 1, 2009 until August 15, 2019. To differentiate them from intervention, prevention, and awareness initiatives, included articles reported at least one approach to evaluate their learning modality. We excluded cross-sectional studies, reviews, and book chapters that only assessed the effect of interventions. Data identifying the learning modality, and evaluation method, level, time interval, and approach were extracted from articles as primary outcomes.

RESULTS

Of 8324 identified studies, 63 articles were eligible for analysis. Most studies stemmed from Africa and Asia (69.8%), were delivered and evaluated face-to-face (74.6% and 76.2%), mainly to professionals (57.1%) and community workers (20.6%). Although the use of online and blended modalities showed an increase over the past 4 years, only face-to-face initiatives were evaluated long-term beyond individual-level. GHCB evaluations in general lacked standardization especially regarding the tools.

CONCLUSION

This is an important resource for evaluating GHCB initiatives in LMICs. It synthesizes evaluation approaches, offers recommendations for improvement, and calls for the standardization of evaluations, especially for long-term and wider impact assessment of online and blended modalities.

A systematic review of global health capacity building initiatives in low-to middle-income countries in the Middle East and North Africa region

INTRODUCTION

Low-and Middle-Income Countries (LMICs) in the Middle East and North Africa (MENA) region are facing increasing global health challenges with a reduced ability to manage them. Global Health Capacity Building (GHCB) initiatives have the potential to improve health workforce performance and health outcomes, however little is known about the GHCB topics and approaches implemented in this region. This is the first systematic review of GHCB initiatives among LMICs in the MENA region.

METHODS

An academic database search of Medline (OVID), PubMed, Scopus, Embase.com , and Open Grey was conducted for articles published between January 2009 and September 2019 in English. Next, a grey literature search following a recommended search framework was conducted. Reviewed records addressed a global health topic, had a capacity building component, looked at specific learning outcomes, and reflected an LMIC in the MENA. Primary outcomes included country, topic, modality, pedagogy, and population.

RESULTS

Reports of GHCB initiatives were retrieved from grey sources (73.2%) and academic sources (26.8%). Most GHCB initiatives were mainly conducted face-to-face (94.4%) to professional personnel (57.5%) through a theoretical pedagogical approach (44.3%). Dominant global health themes were non-communicable diseases (29.2%), sexual and reproductive health (18.4%), and mental health (14.5%). When matched against the Global Burden of Disease data, important gaps were found regarding the topics of GHCB initiatives in relation to the region's health needs. There were limited reports of GHCB initiatives addressing conflict and emergency topics, and those addressing non-communicable disease topics were primarily reported from Egypt and Iran.

CONCLUSION

Innovative and practicum-based approaches are needed for GHCB initiatives among LMICs in the MENA region, with a focus on training community workers. Regional and country-specific analyses of GHCB initiatives relative to their health needs are discussed in the manuscript based on the results of this review.

Development and Assessment of a Gastroscopy Electronic Learning System for Primary Learners: Randomized Controlled Trial

Background

Endoscopic examination is a popular and routine procedure for the diagnosis and treatment of gastrointestinal (GI) diseases. Skilled endoscopists are in great demand in clinical practice, but the training process for beginners to become endoscopy specialists is fairly long. Convenience and a self-paced, learner-centered approach make electronic learning (e-learning) an excellent instructional prospect.

Objective

This study aimed to develop and apply an e-learning system in gastroscopy teaching and learning and to evaluate its effectiveness and user satisfaction.

Methods

The e-learning software Gastroscope Roaming System was developed for primary learners. The system simulates the real structure of the upper gastrointestinal (UGI) tract to teach the main characteristics of gastroscopy under both normal conditions and conditions of common UGI tract diseases. A randomized controlled trial was conducted. Participants were randomly allocated to an e-learning group (EG)or a non–e-learning control group after a pretest. On completing the training, participants undertook a posttest and gastroscopy examination. In addition, the EG completed a satisfaction questionnaire.

Results

Of the 44 volunteers, 41 (93%) completed the gastroscopy learning and testing components. No significant pretest differences were found between the intervention and control groups (mean 50.86, SD 6.12 vs mean 50.76, SD 6.88; P=.96). After 1 month of learning, the EG’s posttest scores were higher (mean 83.70, SD 5.99 vs mean 78.76, SD 7.58; P=.03) and improved more (P=.01) than those of the control group, with better performance in the gastroscopy examination (mean 91.05, SD 4.58 vs mean 84.38, SD 5.19; P<.001). Overall, 85% (17/20) of the participants were satisfied with the e-learning system, and 95% (19/20) of the participants considered it successful.

Conclusions

E-learning is an effective educational strategy for primary learners to acquire skills in gastroscopy examination and endoscopic imaging of the GI tract.

Trial Registration

Chinese Clinical Trial Registry ChiCTR-IOR-17013091; http://www.chictr.org.cn/showproj.aspx?proj=22142

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

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

Blended learning mediated fostering of students' engagement in an undergraduate medical education module

This article was migrated. The article was marked as recommended. Introduction The study investigated students' perception of introducing blended learning strategies to engage and motivate them towards lecture halls and Problem Based Learning (PBL) sessions for improving the quality of the overall students' learning experience. Methods A prospective study was conducted at the Aga Khan University Medical College involving a total of one hundred four (104) year II medical students for the Endocrine and Reproduction module in the academic year 2018. This module ran for six weeks. Modifications in teaching methods were made for this module introduced after approval from Endocrine & Reproduction module, year II and curriculum committees. Written informed consent was obtained from facilitators and students. To assess the effectiveness of modifications introduced, students' feedback was taken on a Likert's scale of 1-5, at the end of the module. Data were analyzed by SPSS version 20. Results Total 94 (90%) students participated in the written feedback. Forty percent medical students (n=38) responded that videos were useful, 54% (n=51) acknowledged that post-PBL activities like crossword puzzles and Kahoot games, created significant discussions amongst students in a fun yet intellectual manner. Seventy percent of students (n=66) agreed that access to Kahoot was easy and no connectivity issues were faced. Twenty percent students (n=20) endorsed that flipped lectures enhanced understanding of topics, 87% students (n=82) felt that recorded lecture was very helpful and flash cards were found helpful by 14% students (n=12). Conclusion Student engagement is an important issue in medical schools in this era. Results showed that blended learning and educational activities enhanced students' learning motivation and interest.

Identifying Opportunity for Online Education to Address HIV/HCV Knowledge Gaps in Health Professionals and Students in Egypt

HCV prevalence rates in Egypt are high. While low, HIV prevalence rates may be underreported. Adequate solutions to address these public health challenges are lacking. Stigma, misperceptions, and lack of specialized skills to deal with infection are persistent impediments. To address these challenges, we propose a plan that incorporates the use of online education and hybrid formats to meet the needs in the field. Online education has been used with success elsewhere in the Mediterranean and Middle East. Given the difficult economic conditions in Egypt and physical challenges of traditional formats of education, we propose a plan, curricular elements, and education tracking process as a strategy to improve the knowledge capacity of health professionals and students.

Identifying Opportunity for Online Education to Address HIV/HCV Knowledge Gaps in Health Professionals and Students in Egypt

HCV prevalence rates in Egypt are high. While low, HIV prevalence rates may be underreported. Adequate solutions to address these public health challenges are lacking. Stigma, misperceptions, and lack of specialized skills to deal with infection are persistent impediments. To address these challenges, we propose a plan that incorporates the use of online education and hybrid formats to meet the needs in the field. Online education has been used with success elsewhere in the Mediterranean and Middle East. Given the difficult economic conditions in Egypt and physical challenges of traditional formats of education, we propose a plan, curricular elements, and education tracking process as a strategy to improve the knowledge capacity of health professionals and students.

The Value of Internet Tools in Undergraduate Surgical Education: Perspective of Medical Students in a Developing Country

OBJECTIVE

Advances in information technology (IT) in the past decade present opportunities and challenges in undergraduate surgical education. There may be need to evaluate the knowledge base and the use of Internet tools among medical students in settings where traditional mode of education is preeminent. This may help to establish a conceptual framework for integrating e-learning into the traditional teaching to enhance learning experience. In this study, we evaluated the medical students' knowledge and use of Internet tools, and their opinion on the application of these tools in surgical education.

METHODS

We undertook a cross-sectional survey of 2013 and 2014 graduating medical class of College of Medicine University of Nigeria, Enugu using structured self-administered questionnaire. The survey assessed the knowledge, utility, and application of Internet tools in surgical education using 5-point Likert scale.

RESULTS

Overall response rate was 78% (227/291) comprising 151 (66.5%) males and 76 (33.5%) females. The median age was 24 years (range 20-33 years). Although 106 (46.7%) had formal training on information technology, 223 (98.2%) can access Internet, and 162 (71.4%) use one or more of the Internet tools, 90.6% (96/106) of those trained on ICT use Internet for education/learning compared to 88.4% (107/121) of those without ICT training (p = 0.76). Google™ search tool had the highest rating in terms of familiarity and utility for education/learning (mean rating 4.3 on a scale of 5.0), while Skype™ had the least rating (mean 2.0). Overall, 89% of respondents (mean rating 4.5 on a scale of 5.0) indicated that Internet tools could be effectively applied in surgical education specifically in areas of lectures, assignments, real-time procedure demonstration, case discussion, and interaction with surgical experts. The key benefits are utility as a regular self-assessment tool (mean rating = 4.6) and offer of flexible learning schedule (mean rating = 4.0). Fifty-two percent (118/227) strongly agree that combination of the use of Internet tools with the traditional teaching may give better learning outcome (mean rating 4.44). The major challenges were cost of accessing Internet (n = 126; 55.5%), lack of facility with the technology (n = 115; 50.7%), and network availability (n = 96; 42.3%). Availability of affordable Internet (n = 205; 90.3%), improvement of training on ICT (n = 135; 59.5%), and encouragement of the use of these tools by faculty (n = 107; 47.1%) were the major suggestions to address the challenges.

CONCLUSION

In our setting, a substantial number of undergraduate medical students are familiar with and use Internet tools for learning and believe that the tools may have utility in surgical education. However, to further consolidate and enhance learning experience, it may be useful to integrate this learning modality with the traditional mode of teaching through a well thought out curriculum modification.

Can blended learning and the flipped classroom improve student learning and satisfaction in Saudi Arabia?

OBJECTIVES

To evaluate student academic performance and perception towards blended learning and flipped classrooms in comparison to traditional teaching.

METHODS

This study was conducted during the hematology block on year three students. Five lectures were delivered online only. Asynchronous discussion boards were created where students could interact with colleagues and instructors. A flipped classroom was introduced with application exercises. Summative assessment results were compared with previous year results as a historical control for statistical significance. Student feedback regarding their blended learning experience was collected.

RESULTS

A total of 127 responses were obtained. Approximately 22.8% students felt all lectures should be delivered through didactic lecturing, while almost 35% felt that 20% of total lectures should be given online. Students expressed satisfaction with blended learning as a new and effective learning approach. The majority of students reported blended learning was helpful for exam preparation and concept clarification. However, a comparison of grades did not show a statistically significant increase in the academic performance of students taught via the blended learning method.

CONCLUSIONS

Learning experiences can be enriched by adopting a blended method of instruction at various stages of undergraduate and postgraduate education. Our results suggest that blended learning, a relatively new concept in Saudi Arabia, shows promising results with higher student satisfaction. Flipped classrooms replace passive lecturing with active student-centered learning that enhances critical thinking and application, including information retention.

A blended design in acute care training: similar learning results, less training costs compared with a traditional format

Introduction There is a demand for more attractive and efficient training programmes in postgraduate health care training. This retrospective study aims to show the effectiveness of a blended versus traditional face-to-face training design. For nurses in postgraduate Acute and Intensive Care training, the effectiveness of a blended course design was compared with a traditional design. Methods In a first pilot study 57 students took a traditional course (2-h lecture and 2-h workshop) and 46 students took a blended course (2-h lecture and 2-h online self-study material). Test results were compared for both groups. After positive results in the pilot study, the design was replicated for the complete programme in Acute and Intensive Care. Now 16 students followed the traditional programme (11 days face-to-face education) and 31 students did the blended programme (7 days face-to-face and 40 h online self-study). An evaluation was done after the pilot and course costs were calculated. Results Results show that the traditional and blended groups were similar regarding the main characteristics and did not differ in learning results for both the pilot and the complete programme. Student evaluations of both designs were positive; however, the blended group were more confident that they had achieved the learning objectives. Training costs were reduced substantially. Conclusion The blended training design offers an effective and attractive training solution, leading to a significant reduction in costs.

Computerized-Aid Medical Training

The application of new technologies in training environments allows the development of new teaching modalities that enable knowledge and ability acquisition in healthcare professionals. Simulation has proven to be an effective method to favor and improve learning as well as to attain the necessary skills to perform a specific technique with greater reliability and security for the patient. We present a new tool or technological development in medical training, through an ultrasound simulator, valid for the knowledge and necessary ability acquisition in the proper infiltration of botulinum toxin guided by ultrasound. This tool benefits from the advantages that new technologies bring when applied in medical training, offering a virtual setting, comfortable and accessible, that does not require the user to move or have access to an ultrasound machine, allowing ultrasound explorations without the existence of a real patient.

Profiling e-health projects in Africa: trends and funding patterns

There is a severe shortage of healthcare provision in Africa. e-Health, the use of Information and Communication Technologies (ICT) to support healthcare, may help to ease this problem. e-Health projects support a wide range of applications ranging from telemedicine to global research collaborations made possible via e-Infrastructures, worldwide systems of integrated advanced high performance networking and computing ICT. To try to understand the state of e-Health in Africa, this paper aims to create a picture and to present an analytical review of some of these initiatives in Africa. A review framework composed of multiple search methods is developed and applied to yield a broad coverage of e-Health projects over the African continent. Seven quantitative analyses on the projects are presented. Major observations include that there is a tendency for e-Health projects to grow in number in some African countries over time; that African countries with larger Gross National Incomes tend to attract more e-Health projects; that e-Health projects in Africa focus on telemedicine, health education and health-related research; that there is a wide range of funding bodies, some of which have a geographical focus, and that the number of m-Health projects has been rising sharply.

Learning styles and preferences for live and distance education: an example of a specialisation course in epidemiology

BACKGROUND

Distance learning through the internet is increasingly popular in higher education. However, it is unknown how participants in epidemiology courses value live vs. distance education.

METHODS

All participants of a 5-day specialisation course in epidemiology were asked to keep a diary on the number of hours they spent on course activities (both live and distance education). Attendance was not compulsory during the course and participants were therefore also asked for the reasons to attend live education (lectures and practicals). In addition, the relation between participants' learning styles (Index of Learning Styles) and their participation in live and distance education was studied.

RESULTS

All 54 (100%) participants in the course completed the questionnaire on attendance and 46 (85%) completed the questionnaire on learning styles. The number of hours attending live education was negatively correlated with the number of hours going studying distance learning materials (Pearson correlation -0.5; p < 0.001). The most important reasons to attend live education was to stay focused during lectures (50%), and to ask questions during practicals (50%). A lack of time was the most important reason not to attend lectures (52%) or practicals (61%). Learning styles were not association with the number of hours spent on live or distance education.

CONCLUSION

Distance learning may play an important role in epidemiology courses, since it allows participants to study whenever and wherever they prefer, which provides the opportunity to combine courses with clinical duties. An important requirement for distance learning education appears to be the possibility to ask questions and to interact with instructors.