Flexible e-learning video approach to improve fundus examination skills for medical students: a mixed-methods study

Abstract

Background Training for the fundus examination using traditional teaching is challenging, resulting in low generalist physicians’ confidence in performing the funduscopic examination. There is growing evidence suggesting a flexible e-learning video approach’s value in teaching physical examination procedures. However, whether the flexible e-learning video approach is superior to the traditional, face-to-face (F2F) lecture-based teaching for the funduscopic exam and the cognitive processes supporting its effectiveness has not yet been determined. Methods We conducted a sequential explanatory mixed-method study to compare the flexible e-learning video approach’s effectiveness versus the F2F lecture-based approach for teaching the funduscopic exam to medical students at Chiba University in Japan. Medical students were randomly assigned to either a flexible e-learning video approach group or a F2F lecture approach group. We then quantitatively measured the diagnostic accuracy of funduscopic findings before and after attending the specific classrooms. Next, we conducted student focus groups to explore the students’ thinking processes in the flexible e-learning video approach vs. the F2F lecture-based teaching of fundus examination. The qualitative data were analyzed using the qualitative content analysis method. Results The mean diagnostic accuracy scores in the post-test significantly increased from pre-test in the intervention group (36.6 to 63.4%, p < 0.001). Post-post comparisons across the two groups revealed a significant difference (intervention group 63.4% vs. control group 34.6%, p < 0.001). Six semi-structured focused group interviews were conducted (n = 36). In the flexible e-learning video approach group, we identified ten categories corresponding to four levels of the revised Bloom’s taxonomy: remember, understand, apply, analyze. Five categories were identified in the traditional F2F lecture approach group corresponding to three revised Bloom’s taxonomy levels: understand, apply, analyze. Interrater reliability was substantial (Cohen’s kappa = 0.81). Conclusions Teaching medical students funduscopic examination using the flexible e-learning video approach leads to improved diagnostic accuracy of funduscopic examinations. The flexible e-learning video teaching method enabled higher cognitive activity levels than the traditional, lecture-based classroom, as assessed using the revised Bloom’s taxonomy. Trial registration This study was registered with the University Hospital Medical Information Network Clinical Trials Registry on 08/02/2020 (Unique trial number: UMIN 000039434).

Effective situation-based delirium simulation training using flipped classroom approach to improve interprofessional collaborative practice competency: a mixed-methods study

“…In this research, content analysis identified a total of nine categories and 17 subcategories corresponding to four levels of the revised Bloom's taxonomy; and the most frequent subcategory by the number of codes was applyin the flipped classroom approach. A study that evaluated the educational effects of flipped classroom method using a modified version of Bloom's Taxonomy also found equivalent results [36]. Mastering a common language, understanding basic knowledge, and practicing applications in simulations may be the factors that have been effective.…”

Investigating medical students’ satisfaction towards video-based learning versus face-to-face lectures: a Jordanian tertiary teaching hospital experience

“…It appears that the utility of e-learning transcends that of providing medical students with lectures in different formats but was also shown to be effective in promoting technical skills. The body of literature shows promising results across the following topics: laboratory skills [43], electrocardiogram visualization and interpretation [44], chronic wound management [45], fundus examination [46], and general ward examination skills (e.g., cannulation, physical examination) [47]. It should be noted that the effectiveness of teaching such skills must be within a blended/hybrid context between e-learning and traditional feedback teaching.…”

Work‐related stress and coping methods of internists and primary care physicians during the COVID‐19 pandemic in Japan: A mixed‐method study

“…22 The transcripts were analyzed using deductive content analysis, drawing upon the stress factors and stress-coping methods as the coding frame with the cognitive process dimensions as the theme categories and subcategories. 23,24 Two authors (TM and KS) performed the open coding of stress factors, and two authors (MS and KS) performed the open coding of stress-coping methods. They independently read and coded all the transcripts.…”