Oral Abstracts: E-Learning

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Presented By: Brianne Lewis, Central Michigan College of Medicine
Co-Authors: Stefanie Attardi, Oakland University William Beaumont School of Medicine
Kara Sawarynski, Oakland University William Beaumont School of Medicine

In the classroom, learners are faced with intrinsic and extrinsic psychological and temporal barriers that may preclude participation and learning. In response, we present an asynchronous instructional design modality, ACQUIRE (ACcessible QUality Interactions and REsponsiveness), which aims to reduce learning barriers while retaining active learning strategies and fostering learner-teacher communication. This study describes and quantifies benefits of the design and aspects for improvement.

The ACQUIRE modality is an asynchronous online session, built using modular software, that allows flexible navigation through short instructional videos, formative assessment questions, and reflection questions, which the teacher responds to directly. The modality was used for 33 basic medical science sessions, taken by three cohorts of 125 medical students. Student narrative feedback comments (n=3075) were extracted from faculty evaluation data. Narrative data were first categorized as positive or constructive feedback. The data were coded openly and descriptively in Google Sheets and grouped into categories.

Data are presented as mean±SD. A majority of comments were positive(76.6%±2.12%) with 43.5%±8.7% of these focused on the ACQUIRE modality. Within these responses, students most benefited from formative practice questions (18.6%±2.3%), the modular format (17.3%±2.7%), engagement with material (11.1%±0.9%), ease of asking questions (9.2%±2.4%), overall organization (8.0±2.8%), and fast responsiveness from the teacher (7%±2.0). Fewer comments were constructive (15.0±2.1%), with (51.5%±30.9%) of these focused on the ACQUIRE modality. More formative questions (30.5%±21.8%) and navigation challenges(9.3%±12.2%) were described for improvement.

This study shows that students feel positive towards the ACQUIRE modality and the benefits rely on teacher behavior/responsiveness and design. These strategies are not LMS-dependent and can be transferred to other platforms.

Faculty Travel Award Nominee

Presented By: Katherine Hyland, University of California, San Francisco
Co-Authors: Jill Bond, University of California, San Francisco
Sam Brondfield, University of California, San Francisco
Heidi Kirsch, University of California, San Francisco
Kelly O'Brien, University of California, San Francisco

Cognitive integration (CI) connects foundational science (FS) to clinical practice and improves reasoning. While evidence supports CI in medical training, the relevance of FS to clinical medicine is often obscure to students, and few learning materials exist to support CI during clerkships. Tools that effectively promote CI may improve clinical reasoning. Thus, we developed and evaluated a FS online lesson for clerkship students. 

Based on prior student feedback regarding the relevance of F S during clerkships, we (an oncologist, a geneticist, and an instructional designer) applied the cognitive theory of multimedia learning to create a 45-minute Qualtrics online lesson (OL) with text, images, questions, and explanations grounded in the hallmarks of cancer (HoC), a key FS principle. To emphasize relevance, we included videotaped patient interviews. We implemented the OL in 2022 and compared feedback to older OLs that were videotaped lectures with interspersed self-assessment questions. 

Out of 138 HoC student views in 2022, 27 submitted feedback compared to 34 feedback submissions total across 16 older OLs from 2020 to 2022. Students rated the HoC OL higher than the older OLs: 1) balance of FS and clinical materials (4.74 vs 4.21, p=0.02); 2) helpfulness in clerkships (4.63 vs 4.21, p=0.08); 3) met learning goals (4.70 v s 4.03, p=0.01). Comments praised the HoC module ("best online lesson I've ever done"), its format ("engaging" and "easy to follow") and the patient videos ("impactful" and a way to "anchor knowledge"). 

Authentic patient stories enhanced FS relevance. Content co-creation by a basic scientist and a clinician aligned with CI goals. Student feedback was highly supportive. This OL can serve as a model for the development of clerkship curricula that promote CI. Limitations include the need for funding, faculty bandwidth, and instructional design assistance. Clerkship-based outcomes were not examined.

Presented By: Brandon Godinich, Texas Tech Health Science Center El Paso
Co-Authors: Jessica Chacon, Texas Tech Health Science Center El Paso
Gilberto Garcia, Texas Tech Health Science Center El Paso
Rivers Hock, Texas Tech Health Science Center El Paso
Nathan Holland, Texas Tech Health Science Center El Paso
Maria Land, Texas Tech Health Science Center El Paso
Mark Raynor, Texas Tech Health Science Center El Paso
Laura Renovato, Texas Tech Health Science Center El Paso

This research focuses on the development and evaluation of an online elective course, "Medicine on the Border: Community Outreach and Challenges," designed for medical and health sciences students at Texas Tech University Health Sciences Center El Paso. The research assesses the effectiveness of the online elective in increasing cultural sensitivity and understanding of community outreach programs. The two-week elective covers topics such as defining community-based research, identifying stakeholders, addressing the social determinants of health, and understanding the role of Community Health Workers.

This prospective post-test study utilizes existing data (pre-assessment) and a post-assessment Qualtrics anonymous survey to evaluate the elective. The survey, consisting of Likert-type scale items and open-ended questions, will gauge students' satisfaction, perceptions of benefits, and the overall impact of the online elective on their awareness of community-based research and outreach.

The study's outcomes are poised to make a substantial contribution to the existing literature on virtual learning electives in medical education. Preliminary data analysis revealed that 75% of respondents aged 25 to 34 and identified as Hispanic or Latino. The cohort unanimously expressed either "Strongly Agree" or "Agree" on the elective's value in providing perspectives, understanding community-based research, stimulating critical thinking in program implementation, and addressing knowledge gaps. All students unanimously affirmed the course's objectives, encompassing distinctions between community engagement and community-based research and knowledge of community programs. This unequivocal endorsement underscores the course's efficacy in meeting its educational goals.

This research addresses a critical need to prepare future healthcare professionals for community engagement with increasing health disparities in Hispanic communities. The elective's development is grounded in principles of community-based participatory research, aiming to create a foundation for students to understand, contribute to, and lead community outreach initiatives. The study's goals encompass scholarly exploration, aligning with broader objectives in health disparities.

Student Presentation, Faculty Travel Award Nominee

Presented By: Jessica Saw, CI Med (MedTerms)
Co-Authors: Anthony Bosshardt, CI Med (MedTerms)
Rand Kittani, CI Med (MedTerms)
Gaurav Nigam, CI Med (MedTerms)
Chad Olson, CI Med (MedTerms)

When designing online learning resources in the medical education space, it is important to understand the medical student experience. Identifying students' study workflows and their pain points is a critical step in developing resources. We collaborated with a professional software design team and used co-design and user-centered design methods to garner information about students' experiences in self-study. This poster summarizes the results derived from the application of these methods.

A series of hour-long focus groups and workshops (n=10 medical students) were run over a six-month period. These sessions, facilitated by an educator and a user experience designer, were divided into three sections: (1) gathering experiences on shortcomings and benefits of existing resources, (2) drawing flowcharts illustrating study habits and resources used, and (3) designing the "ideal" structure for delivery of a specified topic. Themes were identified as "user requirements" for the software development team.

Our findings showed that students need support in making mental maps of disease relationships (e.g., organizing diseases/conditions into categories and sub-categories, relating diseases that affect multiple organ systems). Students also identified a need for several interactive tools, including one that would help them compare similarly presenting diseases, and one that would list the differential diagnosis given a single clinical symptom. Students also showed appreciation for content that was relevant to their level of training, easily searchable, and supplemented by self-assessment.

User-centered design methods identified multiple student needs not yet addressed by existing educational resources. These results illustrate "problem versus solution discovery" and prevents designing solutions to the wrong problems. The results from this study will be used to design the next iteration of MedTerms, an online resource co-designed by medical students at the University of Illinois Urbana-Champaign.

Student Presentation, Best Student Oral Presentation Nominee

Presented By: Joshua Roshal, University of Texas Medical Branch

The Surgical Council on Resident Education (SCORE) web portal is an e-learning platform that delivers a standardized, comprehensive curriculum for surgical residents. Engagement with SCORE content correlates with higher performance on the American Board of Surgery In-Training Examination (ABSITE), which subsequently correlates with first-time pass rates on the written examination component for board certification. In 2019, the American Board of Surgery (ABS) merged with SCORE, and in 2022 the ABS announced the transition to an entrustable professional activities (EPA) training model. The potential of SCORE to guide surgical residents in EPA-based competency evaluation remains undetermined. This study analyzes SCORE web portal modules using evidence-based multimedia design principles that have informed effective e-learning in a variety of settings and proposes suggestions to enhance content delivery.

Based on the Central Limit Theorem, 30 core general surgery modules were randomly chosen from the SCORE web portal to ensure a representative sample. The analysis focused on the main webpage content and omitted supplementary sidebar materials. 2 raters assessed the modules using 12 evidence-based principles from the 4th edition of e-Learning and the Science of Instruction by Ruth C. Clark and Richard E. Mayer.

The majority of SCORE modules analyzed (57%) contained text only and did not adhere to the basic principles for e-learning multimedia design. Of the remaining modules that incorporated both text and graphics, 62% included overly complex graphics, 54% had graphics not positioned near their corresponding text, and none featured audio explanations or virtual coaches.

SCORE modules do not adequately reflect contemporary e-learning multimedia design principles. To improve content delivery and learning outcomes, future modules should feature graphics, audio explanations, and virtual coaches.

Presented By: Michael Herr, University of Alabama at Birmingham
Co-Authors: Christopher Cesiro, University of Alabama at Birmingham
James Martin, University of Alabama at Birmingham

Anatomical donor dissection remains a critical component of health science education. Basic science educator shortages and increased enrollment necessitate the evolution of outdated teaching methods. Learner use of dissection videos has historically shown mixed outcomes. Moreover, recently reported video creation methods are unwieldy, expensive, and inefficient. We propose a simple, time- and cost-efficient way to increase student engagement and discuss the outcomes, pearls, and pitfalls of creating an "eDissection" manual. 

A GoPro camera was mounted to a microphone stand providing a low-profile, affordable method of creating 42 short donor dissection videos (length range: 0:34 - 3:02 [MM:SS]). The Rise 360 web-app was used to generate unique training modules exported and securely disseminated to learners. Students engaged with content before and during sessions to guide dissection steps and view interactive structure checklist. Embedded GIF images guided technique; built-in sorting, matching, and flashcard quizzes provided retrieval practice and immediate feedback to learners. Qualtrics evaluation surveys gathered feedback and suggestions for improvements. 

Responses (n=52) from ratings and narrative feedback indicated that learners found the modules helpful to guide dissection (8.8/10 ± 1.3) and understand content (8.6/10 ± 1.5). The modules were easier to follow than traditional laboratory manuals and were preferred because they alleviated prep anxiety and provided more knowledge about specific expectations. Suggestions for improvement included more videos, tagged structures on donors that the students could identify on their own, and more active learning and retrieval practice activities. 

The use of a novel "eDissection" manual web-app is preferred by students over traditional commercial and in-house manuals. The creation process was time- and cost-efficient and is easy to replicate. Interactive features of the manual are largely preferred by learners. These improvements to outdated laboratory pedagogy are an example of how healthcare education can evolve to meet the needs of learners.

Presented By: Thomas McNamara, Boston University Chobanian & Avedisian School of Medicine
Co-Authors: Molly Cohen-Osher, Boston University Chobanian & Avedisian School of Medicine
Priya Garg, Boston University Chobanian & Avedisian School of Medicine
Cameron Hill, Boston University Chobanian & Avedisian School of Medicine
Caitlin Neri, Boston University Chobanian & Avedisian School of Medicine
Gwynneth Offner, Boston University Chobanian & Avedisian School of Medicine
Roey Ringel, Boston University Chobanian & Avedisian School of Medicine
Luke Scheuer, Boston University Chobanian & Avedisian School of Medicine
Jonathan Wisco, Boston University Chobanian & Avedisian School of Medicine

Our medical school's preclinical curriculum redesign places a strong emphasis on faculty-created self-learning guides (SLGs) as an alternative content delivery mechanism to traditional lectures. Comprising self-paced videos and accompanying text and images, SLGs aim to prepare students for active classroom engagement involving case and team based learning application and discussion. Through the evolution of the curriculum, the understanding of extrinsic cognitive load theory becomes pivotal, compelling instructors to carefully consider the presentation and preparation of multimedia educational materials. The aim of this study was to understand students' engagement and preferences for content that accompanies SLG videos. 

In 2023, a 40-question likert survey was sent to all M2 class students and faculty who had created SLGs at one medical school via Qualtrics. The survey included questions in the following areas: Student and faculty preferences around SLG format and how they engage with the SLG content. Additionally, a subset of students (n=11) participated in a qualitative focus group, with data analyzed using grounded theory.  

Faculty members (n=18/58) and students (n=72/158) completed the survey. Data from the survey and focus groups revealed a notable disjunction: While 76% of students prefer text, images, and diagrams that summarize the main points of videos instead of content that goes into more detail or adds new information, only 50% of faculty utilize this practice. Students rely on succinct post-video summaries that utilize bulleting and bolding of key terms for self-assessment and for revisiting material in second-pass study.  

As faculty create SLGs for students, the use of text, video, and images should be considered carefully and purposefully to minimize extrinsic load and maximize efficiency toward meeting intended learning outcomes. Faculty development that emphasizes cognitive load theory principles pertinent to content creation would greatly enhance the learning experience.

Student Presentation