Blending Gagne's Instructional Model with Peyton's Approach to Design an Introductory Bioinformatics Lesson Plan for Medical Students: Proof-of-Concept Study

Effectiveness of Gagné's 9 Events of Instruction in health professions education: a systematic review and meta-analysis

Objective

This review assesses the effectiveness of Gagné's 9 Events of Instruction in improving theoretical scores and clinical practice abilities in medical education.

Methods

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two researchers conducted a comprehensive search of Chinese and English electronic databases (Web of Science, PubMed, Embase, Cochrane Library, CNKI, VIP, Wanfang). The participants included clinical medical students, nursing students, specialized medical students, and medical interns, among others related to healthcare. Educators used Gagné's 9 Events of Instruction to guide these populations in theoretical learning and/or daily clinical practice. The search was conducted from the inception of the databases to February 27, 2025. Two researchers independently identified, selected, and extracted data from the studies, assessed the quality using the Cochrane Risk of Bias tool, and performed meta-analyses using RevMan 5.4 and Stata 17.0.

Results

A total of 11 studies involving 825 participants were included in the meta-analysis, including 5 RCTs and 6 CSs. In the cumulative meta-analysis, compared with the traditional LBL model, Gagné's 9 Events of Instruction significantly improved learners' KES (SMD 1.55, 95% CI: 0.81 to 2.29; p < 0.00001), PS (SMD 1.83, 95% CI: 1.19 to 2.47; p < 0.00001), LC (OR 4.92, 95% CI: 3.13 to 7.73; p < 0.0001), and TS (OR 7.86, 95% CI: 3.22 to 19.20; p < 0.0001).

Conclusion

The meta-analysis indicated that, compared to traditional medical teaching models, Gagné's 9 Events of Instruction are significantly effective in health professions education and can effectively enhance learners' KES, PS, LC, and TS.

Teaching Procedural Skills: Integrating Educational Theory Into Practice

Introduction

Teaching procedural skills is an essential part of health professions education, yet formal training is often lacking from traditional curricula.

Methods

A workshop on teaching procedural skills was developed as part of a clinician educator track at a large health professions university. Participants included medical residents and fellows (postgraduate years 2-6) from various training programs. The 90-minute, interactive training integrated Gagne's model of instructional design with evidence-based teaching practices. Workshop outcomes were evaluated with pre- and postworkshop surveys. Learner reactions (Kirkpatrick level 1) were assessed via course evaluation. Learning and behavior (Kirkpatrick level 2) were evaluated via attitudinal and knowledge-based questions. Data were collected from three cohorts of participants (2022-2024). Responses were analyzed by paired t test.

Results

Residents and fellows from 11 different disciplines participated in the workshops. The survey response rate was 30 out of 35 (86%). Course evaluations were positive for all six questions (mean scores: 4.8-5.0 on a 5-point Likert scale [1 = strongly disagree, 5 = strongly agree]). Postworkshop scores improved significantly for all five attitudinal questions, including "I can apply instructional design theory when teaching procedural skills" (pre: 2.2 vs. post: 4.3 on a 5-point scale, p < .01). The number of participants correctly answering the knowledge-based questions also increased following the workshop.

Discussion

A workshop focused on evidence-based teaching of procedural skills was well reviewed and improved participants' attitudes and knowledge. Strengths of the workshop include its appeal to a broad range of medical trainees, integration of educational theory, and interactive design.

A Thousand Words About Modern Medical Education: A Mini-Review Concerning the Theory of Education

The present article represents a mini-review and a reflective essay concerning modern medical education methods, as well as ways to adapt them to medical education's local conditions (disciplines), including basic medical sciences. We introduced Gagné's theory of learning and other theories – Constructivist, Experiential, and Humanistic – followed by Dennik's "twelve tips" for effective learning and Harden's ten questions for curriculum development. Outcome-based education (OBE) was discussed and related to relevant concepts within Miller's pyramid and Bloom's taxonomy. Harden's SPICES model was emphasized concerning education strategies while discussing the assessment of learning (AoL), assessment as learning (AaL), and assessment for learning (AfL). Finally, the authors advise exploring the adaptation of modern education methods for a specific discipline of basic medical sciences – Human Anatomy – by incorporating the abovementioned concepts and integrating different AfL and AaL assessment tools while conveying a graphical concept map for this scenario.

Design, Implementation, and Evaluation of a Distance Learning Framework to Adapt to the Changing Landscape of Anatomy Instruction in Medical Education During COVID-19 Pandemic: A Proof-of-Concept Study

This study presents the design of a DL-framework to deliver anatomy teaching that provides a microfiche of the onsite anatomy learning experience during the mandated COVID-19 lockdown. First, using nominal-group technique, we identified the DL learning theories to be employed in blueprinting the DL-framework. Effectiveness of the designed DL-framework in anatomy teaching was demonstrated using the exemplar of the Head and Neck (H&N) course during COVID-19 lockdown, in the pre-clerkship curriculum at our medical school. The dissemination of the DL-framework in the anatomy course was informed by the Analyse, Design, Develop, Implement, and Evaluate (ADDIE) model. The efficiency of the DL-framework was evaluated using the first two levels of Kirkpatrick's model. Versatility of the DL-framework was demonstrated by aligning its precepts with individual domains of key learning outcomes framework. The framework's blueprint was designed amalgamating principles of: Garrison's community inquiry, Siemens' connectivism and Harasim's online-collaborative-learning; and improved using Anderson's DL-model. Following the implementation of the DL-framework in the H&N course informed by ADDIE, the framework's efficiency was evaluated. In total, 70% students responded to the survey assessing perception toward DL (Kirkpatrick's Level: 1). Descriptive analysis of the survey results showed that the DL-framework was positively received by students and attested that students had an enriched learning experience, which promoted collaborative-learning and student-autonomy. For, Kirkpatrick's Level: 2 i.e., cognitive development, we compared the summative assessment performance in the H&N course across three cohort of students. The results show that the scores of the cohort, which experienced the course entirely through DL modality was statistically higher (P < 0.01) than both the other cohorts, indicating that shift to DL did not have an adverse effect on students' learning. Using Bourdieu's Theory of Practice, we showed that the DL-framework is an efficient pedagogical approach, pertinent for medical schools to adopt; and is versatile as it attests to the key domains of students' learning outcomes in the different learning outcomes framework. To our knowledge this is the first-study of its kind where a rationale and theory-guided approach has been availed not only to blueprint a DL framework, but also to implement it in the MBBS curriculum.

The effect of multi-stage mobile training based on Gagne instructional design on learning, retention, and satisfaction of health volunteers

BACKGROUND

One of the most important ways to acquire knowledge in the present age is education based on new technologies, including mobile learning. The purpose of this study was to investigate the effect of a multi-stage mobile training based on Gagne instructional design on learning, retention, and satisfaction of health volunteers.

MATERIALS AND METHODS

In this interventional study, 112 health volunteers a Health Centre in Mashhad during 2019-2020 were enrolled. The participants were randomly divided into two groups: mobile education based on Gagne model (n = 56) and conventional lecture (n = 56). A researcher-made questionnaire was completed by the eligible subjects before, after, and 2 months after the intervention to assess their learning, retention and satisfaction in educational methods. Face validity, content validity, and reliability of the data collection tool and model fitness indices were confirmed. Content validity of data collection tools verified by experts and its reliability was calculated to be 0.78. The collected data were analyzed in SPSS-25, using descriptive (mean and standard deviation [SD]) and analytical statistical tests (independent t-test).

RESULTS

The results showed that 2 days and 2 months after the intervention, learning, and retention rate was significantly higher in the mobile learning based on Gagne model group in comparison to conventional lecture group (P < 0.001). Furthermore, the intervention group was generally satisfied with the mobile training method.

CONCLUSION

Mobile learning based on Gagne model is recommended for improving learning, retention among health-care workers.

Design, Implementation and Evaluation of a Distance Learning Framework to Expedite Medical Education during COVID-19 pandemic: A Proof-of-Concept Study

BACKGROUND

The COVID-19 pandemic has forced medical schools to suspend on-campus live-sessions and shift to distance-learning (DL). This precipitous shift presented medical educators with a challenge, 'to create a "simulacrum" of the learning environment that students experience in classroom, in DL'. This requires the design of an adaptable and versatile DL-framework bearing in mind the theoretical underpinnings associated with DL. Additionally, effectiveness of such a DL-framework in content-delivery followed by its evaluation at the user-level, and in cognitive development needs to be pursued such that medical educators can be convinced to effectively adopt the framework in a competency-based medical programme.

MAIN

In this study, we define a DL-framework that provides a 'simulacrum' of classroom experience. The framework's blueprint was designed amalgamating principles of: Garrison's community inquiry, Siemens' connectivism and Harasim's online-collaborative-learning; and improved using Anderson's DL-model. Effectiveness of the DL-framework in course delivery was demonstrated using the exemplar of fundamentals in epidemiology and biostatistics (FEB) course during COVID-19 lockdown. Virtual live-sessions integrated in the framework employed a blended-approach informed by instructional-design strategies of Gagne and Peyton. The efficiency of the framework was evaluated using first 2 levels of Kirkpatrick's framework. Of 60 students, 51 (85%) responded to the survey assessing perception towards DL (Kirkpatrick's Level 1). The survey-items, validated using exploratory factor analysis, were classified into 4-categories: computer expertise; DL-flexibility; DL-usefulness; and DL-satisfaction. The overall perception for the 4 categories, highlighted respondents' overall satisfaction with the framework. Scores for specific survey-items attested that the framework promoted collaborative-learning and student-autonomy. For, Kirkpatrick's Level 2 that is, cognitive-development, performance in FEB's summative-assessment of students experiencing DL was compared with students taught using traditional methods. Similar, mean-scores for both groups indicated that shift to DL didn't have an adverse effect on students' learning.

CONCLUSION

In conclusion, we present here the design, implementation and evaluation of a DL-framework, which is an efficient pedagogical approach, pertinent for medical schools to adopt (elaborated using Bourdieu's Theory of Practice) to address students' learning trajectories during unprecedented times such as that during the COVID-19 pandemia.

The effectiveness of the Peyton's 4-step teaching approach on skill acquisition of procedures in health professions education: A systematic review and meta-analysis with integrated meta-regression

Background

Acquisition of procedures is an important element in health professions education. Traditionally procedures are taught using a "see one - do one" approach. That is a teacher demonstrates and describes a procedure and afterwards the students practice the procedure. A more recent teaching approach for the acquisition of procedural skills was presented by Walker and Peyton. Peyton's teaching approach is a stepwise teaching approach and consists of the following four steps: demonstration, deconstruction, comprehension and performance. The aims of this study were (i) to systematically evaluate the effectiveness of Peyton's 4-step teaching approach on the acquisition of procedural skills in health professions education and (ii) to evaluate whether studies with fewer students per teacher showed a larger between group difference than studies with more students per teacher.

Methods

We searched in Medline, PsycInfo, Embase and ERIC for eligible studies. Records were screened by two independent reviewers. A random effects meta-analysis was performed to evaluate skill acquisition and time needed to perform the procedures at post-acquisition and retention tests. A meta-regression was used to explore the effect of the number of students per teacher on the estimated effect of the educational interventions.

Results

An effect size of 0.45 SMD (95% CI [0.15; 0.75]) at post-acquisition and 0.7 SMD (95% CI [-0.09; 1.49]) at retention testing were in favour of Peyton's teaching approach for skill acquisition. The groups using Peyton's teaching approach needed considerably less time to perform the procedure at post-acquisition (SMD: -0.8; 95% [CI -2.13 to 1.62]) and retention (SMD: -2.65; 95% CI [-7.77 to 2.47]) testing. The effectiveness of Peyton's teaching approach was less clear in subgroup analyses using peer teachers. Meta-regression showed that the number of students per teacher was an important moderator variable.

Conclusion

Peyton's teaching approach is an effective teaching approach for skill acquisition of procedural skills in health professions education. When peer students or student tutors are used as teachers the effectiveness of Peyton's teaching approach is less clear. Peyton's teaching approach is more effective when small groups with few students per teacher are used.

Thanatogenomic Investigation of the Hydroxymethylome and Mitochondrial Genome of Cadaveric Cardiomyocytes: Proposal for a Proof-of-Concept Study

Background

Cardiovascular disease (CVD) remains the leading cause of death in the United Arab Emirates (UAE). One of the common CVDs is hypertrophic cardiomyopathy (HCM). Recent studies conducted in heart cells of mice have shown that this condition involves a chemical modification called hydroxymethylation of the DNA of heart cells.

Objective

Objectives of the proposed research are to profile the distribution of 5-hydroxymethylation in the cardiomyocyte (CMC) genome of cadaveric cardiac tissue and cardiac biopsy specimens; to compare the hydroxymethylome of cadaveric CMCs with that of cardiac biopsy specimens from HCM patients and/or cardiac transplant patients (control) undergoing cardiac catheterization; to histologically appraise sarcomere distribution and mitochondrial morphology of CMCs in the presence of HCM; to correlate the mitochondrial genome with the HCM phenotype; and to integrate anatomy with biochemistry and genetics into the instructional design of HCM in the core medical curriculum at Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU).

Methods

Normal and hypertrophic heart specimens will be obtained from 8 whole-body cadavers (2/8, 25% control and 6/8, 75% HCM). Myocardial biopsy specimens will be obtained from cardiothoracic and transplant units at the Cleveland Clinic in Abu Dhabi, UAE. As this is a proof-of-concept study, we plan to recruit 5 patients with HCM, where HCM has been diagnosed according to the guidelines of the 2014 European Society of Cardiology Guidelines. Patients with valvular heart disease, history of myocarditis, regular alcohol consumption, or cardiotoxic chemotherapy will be excluded. The control biopsy specimens will be obtained from patients who had received heart transplants. Three investigational approaches will then be employed: (1) gross anatomical evaluation, (2) histological analysis, and (3) profiling and analysis of the hydroxymethylome. These investigations will be pursued with minor modifications, if required, to the standard protocols and in accordance with institutional policy. The objective associated with the education of health professionals will be addressed through a strategy based on Graham’s knowledge translation model.

Results

This study is at the protocol-development stage. The validated questionnaires have been identified in relation to the objectives. The MBRU and the Cleveland Clinic Abu Dhabi Institutional Review Board (IRB) are reviewing this study. Further clarification and information can be obtained from the MBRU IRB. There is funding in place for this study (MBRU-CM-RG2019-08). Currently, we are in the process of standardizing the protocols with respect to the various molecular techniques to be employed during the course of the study. The total duration of the proposed research is 24 months, with a provision for 6 months of a no-cost extension.

Conclusions

The spectrum of CVDs has recently received significant focus from the public health sector in the UAE. HCM is a common familial heart disease, contributing to the sudden increase in the mortality rate of young Emiratis in the UAE. Incorporating artificial intelligence into the identification of epigenetic risk factors associated with HCM will promote accurate diagnosis and lead to the development of improved management plans, hence, positive patient outcomes. Furthermore, integration of these findings into the instructional design of undergraduate, postgraduate, and continuous professional development medical curricula will further contribute to the body of knowledge regarding HCM.

International Registered Report Identifier (IRRID)

PRR1-10.2196/17241

Investigating the Relationship Between Resilience, Stress-Coping Strategies, and Learning Approaches to Predict Academic Performance in Undergraduate Medical Students: Protocol for a Proof-of-Concept Study

Background

The evolution of an undergraduate medical student into an adept physician is perpetual, demanding, and stressful. Several studies have indicated medical students have a higher predominance of mental health problems than other student groups of the same age, where medical education acts as a stressor and may lead to unfavorable consequences such as depression, burnout, somatic complaints, decrease in empathy, dismal thoughts about quitting medical school, self harm and suicidal ideation, and poor academic performance. It is imperative to determine the association between important psychoeducational variables and academic performance in the context of medical education to comprehend the response to academic stress.

Objective

The aim of this proof-of-concept study is to determine the relationship between resilience, learning approaches, and stress-coping strategies and how they can collectively predict achievement in undergraduate medical students. The following research questions will be addressed: What is the correlation between the psychoeducational variables resilience, learning approaches, and stress-coping strategies? Can academic performance of undergraduate medical students be predicted through the construction of linear relationships between defined variables employing the principles of empirical modeling?

Methods

Study population will consist of 234 students registered for the MBBS (Bachelor of Medicine, Bachelor of Surgery) at Mohammed Bin Rashid University of Medicine and Health Sciences distributed over 4 cohorts. Newly registered MBBS students will be excluded from the study. Various psychoeducational variables will be assessed using prevalidated questionnaires. For learning approaches assessment, the Approaches and Study Skills Inventory for Students questionnaire will be employed. Resilience and stress-coping strategies will be evaluated using the Wagnild-Young resilience scale and a coping strategies scale derived from Holahan and Moos’s Coping Strategies Scale, respectively. Independent variables (resilience, stress-coping strategies, and learning approaches) will be calculated. Scores will be tested for normality by using the Shapiro-Wilk test. An interitem correlational matrix of the dependent and independent variables to test pairwise correlation will be formed using Pearson bivariate correlation coefficients. Regression models will be used to answer our questions with type II analyses of variance in tests involving multiple predictors. Regression analyses will be checked for homogeneity of variance (Levine test) and normality of residuals and multicollinearity (variance inflation factor). Statistical significance will be set at 5% (alpha=.05). Effect sizes will be estimated with 95% CIs.

Results

Psychoeducational instruments in the form of validated questionnaire have been identified in relation to the objectives. These questionnaires have been formatted for integration into Google forms such that they can be electronically distributed to the consenting participants. We submitted the proposal to MBRU institutional review board (IRB) for which exemption has been awarded (application ID: MBRU-IRB-2019-013). There is no funding in place for this study and no anticipated start date. Total duration of the proposed research is 12 months.

Conclusions

Psychoeducational instruments used in this study will correlate resilience, stress-coping strategies, and learning approaches to academic performance of undergradudate medical students. To the best of our knowledge, no study exploring the multidimensional association of key psychoeducational variables and academic performance in undergraduate medical students has been pursued. Investigated variables, resilience, learning approaches, and stress-coping strategies, are individual traits, however; students’ learning history before they joined MBRU is unknown, so our research will not be able to address this specific aspect.

International Registered Report Identifier (IRRID)

PRR1-10.2196/14677

Peer-assisted learning (PAL): skills lab tutors' experiences and motivation

BACKGROUND

Peer-assisted learning (PAL) is a common teaching and learning method in medical education worldwide. In the setting of skills laboratories (skills labs), student tutors are often employed as an equivalent alternative to faculty teachers. However, to the best of our knowledge, there is a lack of qualitative studies which explore the reasons for the personal commitment of student tutors. The aim of our study was to examine how undergraduate students experienced and evaluated their roles as skills lab student tutors, what their motivation was, and whether social and cognitive congruence played a role in their teaching experiences.

METHODS

We conducted in-depth, semi-structured interviews with student tutors who were currently teaching in a skills lab. After the interviews had been transcribed verbatim, two independent investigators performed a qualitative content analysis according to Mayring.

RESULTS

In total, we conducted nine interviews with student tutors. Our results revealed that all student tutors showed great enthusiasm and motivation for their jobs as peer teachers. One of the main motivating factors for student tutors to teach in a skills lab was the possibility to simultaneously share and improve their knowledge and expertise. In general, the participants of our study had high aspirations for their teaching. They found it particularly important to be empathetic with the student learners. At the same time, they thought they would personally benefit from their teaching activities and develop a certain expertise as student tutors.

CONCLUSIONS

With the present study we are able to gain some insight into what motivates student tutors to teach in a skills lab and what kind of experiences they have. Our results provide an important input for the future training of highly qualified student tutors.

Augmenting Flexnerism Via Twitterism: Need for Integrating Social Media Application in Blueprinting Pedagogical Strategies for Undergraduate Medical Education

BACKGROUND

Flexnerism, or "competency-based medical education," advocates that formal analytic reasoning, the kind of rational thinking fundamental to the basic sciences, especially the natural sciences, should be the foundation of physicians' intellectual training. The complexity of 21st century health care requires rethinking of current (medical) educational paradigms. In this "Millennial Era," promulgation of the tenets of Flexnerism in undergraduate medical education requires a design and blueprint of innovative pedagogical strategies, as the targeted learners are millennials (designated as generation-Y medical students).

OBJECTIVE

The aim of this proof-of-concept study was to identify the specific social media app platforms that are selectively preferred by generation-Y medical students in undergraduate medical education. In addition, we aimed to explore if these preferred social media apps can be used to design an effective pedagogical strategy in order to disseminate course learning objectives in the preclinical phase of a spiral curriculum.

METHODS

A cross-sectional survey was conducted by distributing a 17-item questionnaire among the first- and second-year medical students in the preclinical phase at the Mohammed Bin Rashid University of Medicine and Health Science.

RESULTS

The study identified YouTube and WhatsApp as the social media app platforms preferred by generation-Y medical students in undergraduate medical education. This study also identified the differences between female and male generation-Y medical students in terms of the use of social media apps in medical education, which we believe will assist instructors in designing pedagogical strategies to integrate social media apps. In addition, we determined the perceptions of generation-Y medical students on the implementation of social media apps in medical education. The pedagogical strategy designed using social media apps and implemented in the Biochemistry course was well accepted by generation-Y medical students and can be translated to any course in the preclinical phase of the medical curriculum. Moreover, the identified limitations of this study provide an understanding of the gaps in research in the integration of social media apps in a medical curriculum catering to generation-Y medical students.

CONCLUSIONS

21st century medical education requires effective use of social media app platforms to augment competency-based medical education: Augmentation of Flexnerism in the current scenario is possible only by the adaptation of Twitterism.