Participants
For the summer term a total number of n= 207 were enrolled in the pediatric course. They were randomly divided in Group A (n=107) and Group B (n=100) by the dean’s office. These two groups were comparable concerning age, gender and prior knowledge level (i.e. courses they have completed so far).
Instruments: implementation of the pediatric E-learning module
The E-learning module consisted of the following components
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1.
“Age guessing” (4 video-based exercises training the skill of estimating the age of children between the age of 3 months and 5 years according to their psychomotoric development)
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2.
Clinical skills online (Cliso) module consisting of 3 VPs (video-based) and background information about pediatric clinical examination skills as preparation for the internship [10]
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3.
7 obligatory, exam relevant VPs (common and relevant diseases)
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4.
6 optional VPs (incentive: certificate when completing all 13 VPs, intended for students with a special interest in pediatrics)
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5.
“Look & Choose” (52 characteristic picture-based exercises dealing with common and relevant signs and symptoms in childhood, e.g. skin rashes, dysmorphic signs)
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6.
"Emergency VP" - Emergency medicine VP to be completed within 24 hours during the mini-internship
Age-Guessing and Cliso were intended to be completed as preparation before entering the pediatric course. Look & Choose was intended to be completed before starting the mini-internship (bedside teaching).
Each learning unit was created by a team of at least one physician supported by a student. The content was reviewed by experts in the clinical field. Before the module started, it was tested and reviewed/evaluated by 15 students. It was designed to match and complement the learning objectives of the pediatric course of the LMU faculty.
The E-learning unit was created with the case-based learning system Casus®, which is suitable to teach clinical reasoning skills [11]. The player allows students to access the VPs and answer the questions. The system is linear with a sequential arrangement of screencards composed of text, multimedia elements, expert comments and questions with immediate quantitative (score) and qualitative (detailed answer comment) feedback. The question formats implemented for this course were multiple and single choice, freetext and mapping questions. For Age guessing and Look & Choose exclusively long text answers, which are not rated by the system, have been used.
The learning objectives covered by the VPs were included on the last screencard.
Although the VPs can be accessed as often as desired, the course setting did not allow students to reset the session in order to answer the questions again or change given answers. The time spent on a VP is cumulative throughout the sessions.
We estimated that students would spend an overall time of about 18 hours working on the E-learning module. This was also stated in the university calendar. This estimation was based on our experience with the integration of VPs in other content domains.
Setting
The pediatric curriculum at the medical faculty of the LMU is structured as a 4 weeks academic course including a 4-day mini-internship at the end. It is held twice per term during the 4th year of medical school. Two groups (A and B) go through this course each term subsequently.
The 4 weeks course comprises
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25 lectures (45 min each; all students)
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7 seminars (90 min each; groups of 20 students)
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8 tutorials/problem based learning (90 min each; groups of 10 – 15 students)
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4 days mini-internship (students are assigned to a pediatric ward and practice history taking and examination under tutorial supervision)
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Intermediate written exam at the end of week 3 before the beginning of the mini-internship consisting of 40 open questions (maximum: 40 points). The exam is based on all course components (lectures, tutorials, seminars, internship and VPs).
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Final exam at the end of the term consisting of 40 MC questions (maximum: 40 points). For this study the results of the final exams were not included due to the different time spans between the intermediate exams and the final exam for the two groups.
An overview about the course is given in Figure 1.
The pediatric course is part of the so-called “periods of life” term, combined with courses in geriatric medicine, rehabilitation, family medicine and obstetrics/gynecology. When students enter this term they have already completed their basic clinical studies including internal medicine and surgery.
The new E-learning module was introduced into the pediatric curriculum during summer term 2009. Students had to register at the Virtual University of Bavaria (vhb) to obtain an account and could then access the modules.
Group A took the 4 week pediatric course during April/May, Group B during June.
Both groups were asked to prepare for the course by working through the clinical skills module (Cliso) and Age-Guessing. For Group A, the obligatory VPs were presented in a timed order. Every week, two VPs were sequentially activated. This was announced at the beginning of the course, but the course participants did not get any further notification during the course. Students were allowed to work in groups, but we did not explicitly encourage them to do so. There was no extra organizing effort on the tutor side, because the spaced activation could be easily done in the course administration tool of the Casus® system.
For Group B, all obligatory VPs were available from the beginning of the course. But they were also instructed to work on two VPs per week.
The optional VPs as well as the Look & Choose modules were available throughout the course for both groups.
Analysis of data
To assess the usage pattern we analyzed the logdata of the sessions in Casus concerning VPs opened, day on which a session was started, duration of session in minutes and score for each answer. A session was counted if at least 50% of the screencards had been completed. This cut-off was arbitrarily set and was based on the curricular approach, where students have to complete at least 50% of cards to get credit for an activity.
We tested for normal distribution using the Shapiro-Wilk test. As all three data sources - VP session duration, scores on answers and results of the intermediate exam - were nearly normally distributed, we applied two-sided t-tests for independent sample-size (level of significance 0.05) to detect differences between group A and B within each data source. The power of the study was assessed 0.99.
The data analysis was done with SPSS, Version 19.
Ethical aspects
The data used for this study have been made anonymous before analysis. Course participants gave consent for the storing and evaluation of session-related data upon registering for the course. This approach was in accordance with the local rules of the regulatory board and therefore an ethical approval was not required for this study.