Blended learning: ten tips on how to implement it into a curriculum in healthcare education

Comparison of the teaching clinical biochemistry in face-to-face and the flex-flipped classroom to medical and dental students: a quasi-experimental study from IRAN

INTRODUCTION

Biochemistry is one of the main courses of basic sciences in the medical curriculum, along with other difficult subjects that are difficult to learn. The emergence of new technologies has made it possible to test new methods such as e-Learning. In this study, we compared two methods of Flex-Flipped Classroom (FFC) and face-to-face.

METHOD

A quasi-experimental research was done which involved both medical and dental students studying the clinical biochemistry course in the joint semester in 2019. A total of 100 medical students were trained in biochemistry through face-to-face teaching, and 60 dental students were trained in the same course through the FFC model. Three researcher-made tools were used to compare the two groups to assess the student's satisfaction, scores, and self-evaluation. The content validity of the tools was checked using the opinions of 10 experts through the CVI index. The results were analyzed using one-sample t-tests, independent t-tests, and ANOVA.

RESULTS

Both groups scored significantly more than the cut-off-point (Mean > 3.5) in their average scores of the total and sub-components of the self-evaluation questionnaire (P < 0.05). Face-to-face teaching was viewed more favorably than the FFC teaching except for considering the flexibility (4.14 ± 1.55), but the difference was not significant (P > 0.05). The students' knowledge score in the FFC was slightly higher than that in the face-to-face method, but this difference was not significant(P = 0.758).

CONCLUSION

Both face-to-face and FFC methods were effective according to the students, but the level of satisfaction with the face-to-face method was higher. It seems that teacher-student interaction is an important factor in students' preferences. However, the students preferred the flexibility of multimedia. It seems necessary to use the advantages of each method in a model appropriate to the students' conditions and available facilities.

Explaining the health system in a practical way - the use of a simulation game in medical sociology teaching

Objective

A simulation game is a valuable method for conveying teaching content in a practical way. The aim was to design a teaching module for medical sociology on the subject of "The German health care system" which would convey the contents and connections to the students in a practical way using a simulation game.

Project description

In addition to the development of scenarios for the simulation game, role cards for various institutions of the health care system were also produced as a result. The students were given the opportunity beforehand to work on theoretical content regarding the German health care system online (the "flipped classroom method"). In the 90-minute face-to-face event the simulation game was played, followed by a feedback session. The initial impressions of the students were collected.

Results

In the 2022 summer semester, a total of 185 students from the 4th pre-clinical semester took part in the seminar. The students were divided into twelve seminars. One scenario was worked on per seminar. The simulation game contributed to a better understanding of the health care system. The students were generally very satisfied with this type of knowledge transfer and thought that this method might well be integrated into teaching in the future.

Conclusion

Communicating the health care system through a simulation game is evidently suitable for explaining clearly complex issues and presenting the various interests of the individual institutions. In addition, a simulation game stimulates critical debate and can contribute to imparting theoretical content in teaching medical sociology in a practical way.

Dental Bite-Sized Bits: A Module for Teaching Common Oral Health Conditions to Multidisciplinary Students

The Surgeon General's report in the year 2000 highlighted the association between chronic diseases and oral health infections. Current healthcare education programs, regrettably, report only 1 to 3 h of oral health instruction within curricula. In the years 2020-2022, as part of their respective oral health curricula, 278 first-year physician assistant and 12 pre-clinical second-year pharmacy students were invited to participate in a voluntary survey examining the effectiveness of animated succinct, online video-based oral health units. Among all student responses for the post-use survey, respondents "strongly agreed" or "agreed" that learning objectives of the unit(s) were achieved after reviewing the videos. Of the participants, 97% "strongly agreed" or "agreed" that the videos helped them understand information of which they had no prior knowledge. Similarly, 98% "strongly agreed" or "agreed" the information was appropriate for their level of knowledge. Most students, 93%, "strongly agreed" or "agreed" the exercise was a valuable learning experience. Regarding the importance of future interprofessional collaboration pertaining to a mutual patient's oral health, 95% of participants "strongly agreed" or "agreed" that they would be likely to collaborate. This study demonstrates the importance of oral health as a critical area of focus in healthcare education. The study also confirms the hypothesis that Dental Bite-Sized Bits units deliver engaging, valuable oral health education for preclinical healthcare learners, incorporating interprofessional perspectives from the disciplines of dental, pharmacy, and physician assistant.

Interprofessional geriatric assessment in nursing home (IgAP): a curricular development in geriatrics

The hallmark of medical action in geriatrics is the interprofessional treatment of the patient by a multi-professional team consisting of doctors, nurses and therapists with the aim of treating the patients primarily in a way that preserves their function and thereby enabling them to live as independently as possible. Therefore, at the beginning of every geriatric treatment, there is a multiprofessional geriatric assessment of functional abilities. With regard to successful medical action, this necessarily requires all health professions involved to understand geriatric patients and their limitations. Under ideal circumstances, their competencies overlap. From the point of view of the related disciplines, this means to teach working together with the other professions - interprofessionally - and learning from one another in order to effectively collaborate. After comparing the existing education in geriatrics within the Medical Curriculum Munich (MeCuM) with the European catalog of learning objectives for geriatricians (UEMS-GMS), a deficit with regard to geriatric assessment was recognized in the field of multi-professional training. Therefore, the existing geriatric curriculum of the Ludwig Maximilians University (LMU) in Munich should be expanded to include an interprofessional course on geriatric assessment. This project report aims to show the development and implementation of this course. For this purpose, the model for curriculum development according to Kern was used by the planners to establish an interprofessional briefing. Due to its innovative character, the course received public recognition and is the basis for the expansion of interprofessionalism in the sense of professional cooperation in geriatrics. Establishing interprofessionalism in other disciplines and locations is welcome.

Curiosity in Online Video Concept Learning and Short-Term Outcomes in Blended Medical Education

Background: A student's level of curiosity in a subject after learning about it through online videos has not been addressed well in the medical education field. The purpose of this study, therefore, was to investigate online learning's effect on the stimulation of curiosity and short-term learning outcomes in a blended framework of precision medical education.

Methods: A mixed-methods research design was used. During the 2020 academic year, all fifth-year medical students who, prior to class, viewed 6 video clips that presented 6 core concepts were invited to complete a survey and self-reflection on their learning process to assess their level of curiosity in each concept. For each group of medical students, teaching assistants helped collect anonymous survey data and summative assessment scores representing the students' learning outcomes. Video-viewing patterns, attained through an action log transformation, were also coded for analysis. Mann–Whitney U and Kruskal–Wallis tests were employed to compare differences between groups, and multiple linear regression was used to select the factors affecting learning outcomes. Qualitative data were content-coded through a descriptive approach using thematic analysis.

Results: Of 142 medical students, 136 watched the online videos, 124 responded to the questionnaires, and 92 provided comments. Students' curiosity levels after learning about each concept through online videos significantly correlated with the degree to which a concept was learned. Medical students spent a median of 1.6 h online, and pause frequency correlated with curiosity in certain concepts. Aroused curiosity was associated with short-term learning outcomes in inconsistent effect sizes and directions. Students' feedback revealed various dimensions of curiosity, including novelty acknowledgment, recognition of an information gap, and information-seeking requests.

Conclusions: Curiosity can be induced through online video learning platforms and has a role in short-term learning outcomes in medical education.

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.

Blended Learning on Blood Pressure Measurement: Investigating Two In-Class Strategies in a Flipped Classroom-Like Setting to Teach Pharmacy Students Blood Pressure Measurement Skills

For reliable blood pressure measurement, various potential sources of inaccuracies need to be considered to avoid incorrect decision-making. Pharmacy students should be sensitized and taught the skill accordingly. One strategy to teach students’ blood pressure measurement skills might be through a blended learning approach in a flipped classroom-like setting. With a randomized two-arm study among pharmacy students in their eighth semester, the required extent of in-class session in the scope of a blended learning approach in a flipped classroom-like setting was evaluated. Participants’ self-confidence and self-perceived proficiency were evaluated through a survey, and participants’ blood pressure measurement performance was assessed by objective structured clinical examination (OSCE). Participants’ satisfaction with, and perception of, the flipped classroom were also surveyed. The extended in-class activities did not result in a significantly higher increase of participants’ OSCE score and self-assessment score when compared to the brief in-class session. Both in-class sessions yielded a significant increase in the OSCE scores as well as in the self-assessment scores. Moreover, the teaching approaches were predominantly well-received by the students. The use of both flipped classroom-like approaches improved pharmacy students’ blood pressure measurement performance, though the brief in-class session was sufficient. Students’ self-confidence/self-perceived proficiency in blood pressure measurement skills increased similarly in both settings.

[E-Learning in pathology]

Digital formats have become an indispensable part of academic teaching, including education and training in pathology. Their use offers the perspective of rendering conventional teaching formats more diversified and more flexible since students can adopt the timing and learning speed to their individual needs. However, digital formats should be designed to fulfill the intended didactic purpose within a teaching concept that addresses competences and specific aims. The current view is that E‑learning neither will nor should replace face-to-face teaching, but that both can fuse into blended-learning formats using the best of both worlds. It is important to view the implementation of E‑learning as a dynamic process that should be underpinned by didactic research and be constantly developed further through evaluation and feedback from both teachers and students.

Practical teaching in undergraduate human and dental medical training during the COVID-19 crisis. Report on the COVID-19-related transformation of peer-based teaching in the Skills Lab using an Inverted Classroom Model

Objective: Drastic restrictions were imposed due to the COVID-19 pandemic, especially relating to the practical training part of the undergraduate human and dental medical training. During emergency mode teaching in the summer semester of 2020, a pilot project on practical classroom teaching under COVID-19 conditions was undertaken the Skills Lab Dresden, the Interprofessional Medical Training Centre (MITZ). Students were able to continue learning basic communication and manual skills. This project report presents the adaptations needed for this teaching concept and discusses their feasibility as well as selected evaluation results of the trial run. Description of the project: In normal teaching, students rotate to complete training sessions in small groups. Teaching is provided in a peer-teaching format. An Inverted Classroom Model was implemented as a teaching concept during emergency operation with preparation through digital learning and classroom teaching. Organisational and teaching adjustments were carried out for the concept and to comply with containment regulations. The concept was evaluated by the students using a standardised online questionnaire. Results: 1012 students completed their training during emergency operation at the university. The containment regulations meant that there were a higher number of training sessions and a higher workload. Only one of the alternative dates provided had to be used for COVID-19-related reasons. Infection chains could be tracked. The majority of students found the communication of information via Moodle to be sufficient and did not experience any technical problems. An analysis of the students' evaluation revealed a high level of overall satisfaction with the adapted teaching concept. Conclusion: The MITZ will once again use the concept in a modified form should there be renewed or continued emergency operation. The Inverted Classroom Model will also be established as an integral part of regular teaching. The findings may be of interest to other Skills Labs to develop concepts for emergency operation teaching to efficiently utilise site-specific resources.