Experiences with using e-learning tools in orthopedics in an uncontrolled field study application.

BACKGROUND: E-learning is widely used in undergraduate medical education and often in blended learning settings for students learning at home. This study should assess the educative value of e-learning tools in orthopedics and traumatology when used under "field" conditions, in comparison with a controlled laboratory-like setting. MATERIALS AND METHODS: Medical students were invited for their voluntary online participation in an uncontrolled study (UCS). They were randomly exposed to digital book chapters or podcasts on four different orthopedic diseases, and then filled in pre-/post-tests and evaluations. Test results indicating insufficient study participation were not included in the subsequent analysis. Results in a gain of knowledge and student's satisfaction were compared to existing data of a randomized controlled trial with the same tools in a laboratory environment (RCT). RESULTS: Among 84 included UCS students and 130 RCT students, podcast learners showed a significantly higher gain of knowledge compared to text learners independent of the learning setting (UCS p<0.011; RCT p<0.001). There were no significant differences in the gain of knowledge for the two different learning tools when comparing each the UCS and RCT settings. Evaluations showed positive ratings for both tools, while podcasts were on the average rated higher than texts were. Significantly more UCS participants (n=46) compared to the RCT (n=34) showed signs of disengagement with the study (p<0.05). DISCUSSION: The findings suggest that it is possible to achieve a similar gain of knowledge with e-learning tools in uncontrolled settings and in RCTs. The role of e-learning materials in voluntary and formative learning settings is of value and should be explored in future studies. LEVEL OF EVIDENCE: III, case-control study.

Superior Gain in Knowledge by Podcasts Versus Text-Based Learning in Teaching Orthopedics: A Randomized Controlled Trial.

OBJECTIVE: Digital learning (e-learning) has become a firm part of surgical undergraduate education. However, there is still a lack in analyzing e-learning tools in experimental settings without potentially biasing curricular influences. This study should compare students' learning outcome with podcasts versus book texts under laboratory conditions in the field of orthopedics. METHODS: Voluntary medical students were randomly assigned for learning either with a book chapter or a podcast about common orthopedic diseases in an isolated computer room. Before and after intervention, students answered multiple-choice tests and questionnaires about their attitudes and satisfaction. The study was conducted from November 2012 to February 2013. RESULTS: Totally, 130 students were included (55 text users and 75 podcast users, 52 males and 78 females). There was a significant increase in the overall knowledge for both groups (p < 0.001). Podcast users scored significantly better in the posttests (p < 0.021) and achieved a significantly higher gain of knowledge compared to text users (p < 0.001). The evaluation also showed a significantly higher approval of podcasts regarding comprehensibility, teaching efficacy, or fun learning with it (p < 0.05). Females gained significantly more knowledge by the use of texts than males did (p = 0.04), without any sex difference when using podcasts. CONCLUSIONS: This study showed a significantly higher gain of knowledge and higher satisfaction from learning with podcasts compared to book texts among students. Podcasts seem to be beneficial when teaching defined orthopedic topics to medical students. Sex plays an additional independent role in the impact of e-learning tools on students' learning outcome.

Learning management system and e-learning tools: an experience of medical students' usage and expectations.

OBJECTIVES: To investigate medical students´ utilization of and problems with a learning management system and its e-learning tools as well as their expectations on future developments. METHODS: A single-center online survey has been carried out to investigate medical students´ (n = 505) usage and perception concerning the learning management system Blackboard, and provided e-learning tools. Data were collected with a standardized questionnaire consisting of 70 items and analyzed by quantitative and qualitative methods. RESULTS: The participants valued lecture notes (73.7%) and Wikipedia (74%) as their most important online sources for knowledge acquisition. Missing integration of e-learning into teaching was seen as the major pitfall (58.7%). The learning management system was mostly used for study information (68.3%), preparation of exams (63.3%) and lessons (54.5%). Clarity (98.3%), teaching-related contexts (92.5%) and easy use of e-learning offers (92.5%) were rated highest. Interactivity was most important in free-text comments (n = 123). CONCLUSIONS: It is desired that contents of a learning management system support an efficient learning. Interactivity of tools and their conceptual integration into face-to-face teaching are important for students. The learning management system was especially important for organizational purposes and the provision of learning materials. Teachers should be aware that free online sources such as Wikipedia enjoy a high approval as source of knowledge acquisition. This study provides an empirical basis for medical schools and teachers to improve their offerings in the field of digital learning for their students.

Evaluation of the free, open source software WordPress as electronic portfolio system in undergraduate medical education.

BACKGROUND: Electronic portfolios (ePortfolios) are used to document and support learning activities. E-portfolios with mobile capabilities allow even more flexibility. However, the development or acquisition of ePortfolio software is often costly, and at the same time, commercially available systems may not sufficiently fit the institution's needs. The aim of this study was to design and evaluate an ePortfolio system with mobile capabilities using a commercially free and open source software solution. METHODS: We created an online ePortfolio environment using the blogging software WordPress based on reported capability features of such software by a qualitative weight and sum method. Technical implementation and usability were evaluated by 25 medical students during their clinical training by quantitative and qualitative means using online questionnaires and focus groups. RESULTS: The WordPress ePortfolio environment allowed students a broad spectrum of activities - often documented via mobile devices - like collection of multimedia evidences, posting reflections, messaging, web publishing, ePortfolio searches, collaborative learning, knowledge management in a content management system including a wiki and RSS feeds, and the use of aid tools for studying. The students' experience with WordPress revealed a few technical problems, and this report provides workarounds. The WordPress ePortfolio was rated positively by the students as a content management system (67 % of the students), for exchange with other students (74 %), as a note pad for reflections (53 %) and for its potential as an information source for assessment (48 %) and exchange with a mentor (68 %). On the negative side, 74 % of the students in this pilot study did not find it easy to get started with the system, and 63 % rated the ePortfolio as not being user-friendly. Qualitative analysis indicated a need for more introductory information and training. CONCLUSIONS: It is possible to build an advanced ePortfolio system with mobile capabilities with the free and open source software WordPress. This allows institutions without proprietary software to build a sophisticated ePortfolio system adapted to their needs with relatively few resources. The implementation of WordPress should be accompanied by introductory courses in the use of the software and its apps in order to facilitate its usability.

An Introduction to the Inverted/Flipped Classroom Model in Education and Advanced Training in Medicine and in the Healthcare Professions.

In describing the inverted classroom model (ICM), the following paper is meant to provide an introduction to the subject matter and to serve as a practical guide for those wishing to employ its methods in basic and advanced medical training and education. The ICM is a blended-learning method in which a self-directed learning phase (individual phase) precedes the classroom-instruction phase. During the online phase, factual knowledge is imparted that serves as a basis for the classroom phase. The classroom phase should subsequently be used to assimilate and implement the previously gained knowledge. In contrast, traditional course concepts impart factual knowledge in lectures, for example, or in other face-to-face teaching formats and are followed by the students' self-instruction in order to assimilate this knowledge. The goal of the ICM is the shift from passive learning to accelerated learning in order to foster learning at cognitively demanding levels such as analysis, synthesis and evaluation. The concurrent increase in production and use of screencasts and educational videos, the Open Educational Resources "movement" and the widespread use of Massive Open Online Courses (MOOCS) have contributed to the increased dissemination of the inverted-classroom method. The intention of the present paper is to provide an introduction to the subject matter and simultaneously to offer a short overview of important projects and research results in the field of medical education and other health professions. Furthermore, an outline is given of the advantages and disadvantages of the model as well as its potential benefit to the future of medical education and training.

Survey of e-learning implementation and faculty support strategies in a cluster of mid-European medical schools.

BACKGROUND: The use of electronic learning formats (e-learning) in medical education is reported mainly from individual specialty perspectives. In this study, we analyzed the implementation level of e-learning formats and the institutional support structures and strategies at an institutional level in a cluster of mid-European medical schools. METHODS: A 49-item online questionnaire was send to 48 medical schools in Austria, Germany and Switzerland using SurveyMonkey®. Data were collected between February and September of 2013 and analyzed using quantities, statistical and qualitative means. RESULTS: The response rate was 71 %. All schools had implemented e-learning, but mainly as an optional supplement to the curriculum. E-learning involved a wide range of formats across all disciplines. Online learning platforms were used by 97 % of the schools. Full-time e-learning staff was employed by 50 %, and these had a positive and significant effect on the presence of e-learning in the corresponding medical schools. In addition, 81 % offered training programs and qualifications for their teachers and 76 % awarded performance-oriented benefits, with 17 % giving these for e-learning tasks. Realization of e-learning offers was rewarded by 33 %, with 27 % recognizing this as part of the teaching load. 97 % would use curriculum-compatible e-learning tools produced by other faculties. CONCLUSIONS: While all participating medical schools used e-learning concepts, this survey revealed also a reasonable support by institutional infrastructure and the importance of staff for the implementation level of e-learning offerings. However, data showed some potential for increasing tangible incentives to motivate teachers to engage in further use of e-learning. Furthermore, the use of individual tools and the distribution of e-learning presentations in various disciplines were quite inhomogeneous. The willingness of the medical schools to cooperate should be capitalized for the future, especially concerning the provision of e-learning tools and concepts.

High efficacy and students' satisfaction after voluntary vs mandatory use of an e-learning program in traumatology and orthopedics--a follow-up study.

INTRODUCTION: Within the last decade, e-learning has gained a consistent place in surgical teaching. However, as the use of new programs is often voluntary, more information on the implications of the data regarding user acceptance and knowledge with mandatory use is desirable, especially in the context of the long-term developments of courses. MATERIALS: Starting in 2009, the e-learning program Network for Students in Traumatology and Orthopedics was offered in a voluntary blended learning context. Students' satisfaction and increase in knowledge were evaluated using questionnaires and written tests. With proven effectiveness, the program became a mandatory part of the curriculum, and students' attitudes and gain of knowledge were re-evaluated in 2010 and 2011 to detect differences in voluntary vs mandatory use. RESULTS: In the evaluation questionnaires (n = 108 voluntary vs n = 361 mandatory), the overall appreciation regarding the offerings remained high. Significantly more students felt better prepared for clinical situations (p < 0.001) and asked for e-tutoring (p = 0.025) with mandatory use. In written tests, both voluntary (n = 70) and mandatory (n = 147) users showed significantly increased knowledge (p < 0.001). Starting with a lower base level (p < 0.001), mandatory users had a significantly higher absolute increase compared with voluntary users (p = 0.015), leading to a similar final level. DISCUSSION: The presented blended learning concept was an efficient way to teach students orthopedics and traumatology. Data can support the assumption that even if the voluntary evaluation of e-learning offerings might be subject to a selection bias, the results can serve as a representative impression for the students' overall mood and their gain in knowledge. However, as changes would have to be anticipated when shifting to mandatory use, users' perceptions should be constantly evaluated.

Blended learning approach improves teaching in a problem-based learning environment in orthopedics - a pilot study.

BACKGROUND: While e-learning is enjoying increasing popularity as adjunct in modern teaching, studies on this topic should shift from mere evaluation of students' satisfaction towards assessing its benefits on enhancement of knowledge and skills. This pilot study aimed to detect the teaching effects of a blended learning program on students of orthopedics and traumatology in the context of a problem-based learning environment. METHODS: The project NESTOR (network for students in traumatology and orthopedics) was offered to students in a problem-based learning course. Participants completed written tests before and directly after the course, followed by a final written test and an objective structured clinical examination (OSCE) as well as an evaluation questionnaire at the end of the semester. Results were compared within the group of NESTOR users and non-users and between these two groups. RESULTS: Participants (n = 53) rated their experiences very positively. An enhancement in knowledge was found directly after the course and at the final written test for both groups (p < 0.001). NESTOR users scored higher than non-users in the post-tests, while the OSCE revealed no differences between the groups. CONCLUSIONS: This pilot study showed a positive effect of the blended learning approach on knowledge enhancement and satisfaction of participating students. However, it will be an aim for the future to further explore the chances of this approach and internet-based technologies for possibilities to improve also practical examination skills.