Cognitive Style and Mobile Technology in E-learning in Undergraduate Medical Education

Conditions

Medical Education

Keywords

cognitive style, e-learning, mobile technology, randomized controlled trial, otolaryngology-head and neck surgery

Brief summary

New designs of 6-year undergraduate medical education (UME) in Taiwan mainly include (1) integral curricula of body organ system, (2) multiple methods of clinical teaching and assessment, and (3) generalism in UME. Accompany with decreasing educational hours in the classrooms and hospital, essential but minor components of primary healthcare such as ophthalmology and otolaryngology-head and neck surgery (ORL-HNS) is disproportionately under-represented in UME. Novel medical education stresses on enabling self-directory learning and increasing learning hours outside the classrooms. Accordingly, we hypothesize that innovations in educational technology can enhance the learning outcomes of ORL-HNS. This study is aimed to determine whether mobile technology in e-learning (M-TEL) is an effective tool for the instruction of ORL-HNS and to compare effects of different cognitive styles on learning outcomes of M-TEL with various modules of medical education. This is a randomized controlled trial. We will recruit 60 UME students without previous training in ORL-HNS to undergo the Group Embedded Figures Test to determine their cognitive styles such as field dependence or field-independence. After blinded randomization, students are instructed on two modules of emergent ORL-HNS disorders, using either a standard e-learning of text-figure Power Point show or an interactive multimedia module. Subjects are evaluated on emergent ORL-HNS disorders using text-based assessment and multimedia assessment take place prior to and following instruction. After 7 days later, they will be assessed using global satisfaction score and AttrakDiff2 questionnaire. We anticipate that this study can confirm M-TEL can enhance the efficiency of the instruction of ORL-HNS and understand differences in learning outcomes of M-TEL with various modules of medical education between field dependence and filed independence using this platform.

Detailed description

Background: New designs of 6-year undergraduate medical education (UME) mainly include (1) integral curricula of body organ system, (2) multiple methods of clinical teaching and assessment, and (3) generalism in UME. UME is meant to enable graduates to become undifferentiated general physicians. Accompany with decreasing educational hours in the classrooms and hospital, essential but minor components of primary healthcare such as ophthalmology and otolaryngology-head and neck surgery (ORL-HNS) is disproportionately under-represented in UME. In Canada, substantial downstream effects on managing ORL-HNS problems have been noted in family medicine residents. In order to improve learning insufficiency and enhance clinical competency without increasing extra-hours in the classrooms and hospitals, novel medical education stresses on enabling self-directory learning and increasing learning hours outside the classrooms. Accordingly, we hypothesize that innovations in educational technology can enhance the learning outcomes of ORL-HNS. Purposes: This study is aimed to determine whether mobile technology in e-learning (M-TEL) is an effective tool for the instruction of ORL-HNS and to compare effects of different cognitive styles on learning outcomes of M-TEL with various modules of medical education. Material and Methods: This is a randomized controlled trial. Firstly, we have been setup a e-learning platform of the Top 10 emergent ORL-HNS disorders with translating into an application (APP) function that can execute in mobile devices. Secondly, we will recruit 60 UME students without previous training in ORL-HNS to undergo the Group Embedded Figures Test to determine their cognitive styles such as field dependence or field-independence. After blinded randomization, students are instructed on two modules of emergent ORL-HNS disorders, using either a standard e-learning of text-figure Power Point show or an interactive multimedia module. Subjects are evaluated on emergent ORL-HNS disorders using a text-based assessment and a multimedia assessment take place prior to and following instruction. Anticipating Outcome: This study can (1) establish a M-TEL of ORL-HNS that can deliver an innovatively mobile e-learning to supplement the deficiency of the classroom hours, (2) confirm M-TEL can enhance the efficiency of the instruction of ORL-HNS, and (3) understand differences in learning outcomes of M-TEL with various modules of medical education between field dependence and filed independence using this platform.

Li‐Ang Lee, Shu‐Ling Wang, Yi‐Ping Chao, Ming‐Shao Tsai, Li‐Jen Hsin et al. (11 authors)

JMIR Medical Education2018-03-0828 citations

10.2196/mededu.9237

Cognitive Style and Mobile E-Learning in Emergent Otorhinolaryngology-Head and Neck Surgery Disorders for Millennial Undergraduate Medical Students: Randomized Controlled Trial

Li‐Ang Lee, Yi‐Ping Chao, Chung‐Guei Huang, Ji‐Tseng Fang, Shu‐Ling Wang et al. (11 authors)

Journal of Medical Internet Research2018-02-1335 citations

10.2196/jmir.8987

Interventions

OTHERmobile technology of e-learning (M-TEL)

UME students learn the Top 10 emergent ORL-HNS disorders using the M-TEL including the IM module or the PPS module.

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

OTHER

Masking

NONE

Intervention model description

This study was a prospective randomized controlled trial.

Eligibility

Sex/Gender

ALL

Age

20 Years to No maximum

Healthy volunteers

Yes

Inclusion criteria

1. Age \> 20 years old; 2. UME students (defined as the three or four years of medical school training).

Exclusion criteria

1. Previous ORL-HNS training; 2. Declining to participate.

Design outcomes

Primary

Measure	Time frame	Description
Percentage Change in Multiple-choice Question (MCQ) Scores	before and immediately after the M-TEL intervention	Subjects will undergo the duplicated 15-minute MCQ tests before after the M-TEL Subjects will undergo the duplicated 15-minute MCQ tests 15 minutes before the M-TEL intervention with either the IM module or the PPS module and immediately after the M-TEL intervention.

Secondary

Measure	Time frame	Description
Global Satisfaction Score	7 days after the M-TEL intervention	Global satisfaction score is measured using a visual analogue scale from 0 (very dissatisfied) to 10 (very satisfied) after 7 days post M-TEL.
AttrakDiff2 Questionnaire: Pragmatic Quality Score	7 days after the M-TEL intervention	For more delicately evaluate the acceptance of technical innovations, we will assess user experience using the AttrakDiff2. AttrakDiff2 is developed as a tool by Hassenzahl's research group to be able to quantify attractive, identifiable, stimulating, and pragmatic qualities. The tool consists of 28 seven-step items whose poles are opposite adjectives (e.g. confusing - clear, unusual - ordinary, good - bad). Each set of adjective items is ordered into a scale of intensity. Each of the mean values of an item group creates a scale value for pragmatic quality (PQ), hedonic stimulation (HQ-S), hedonic identification (HQ-I), and attractiveness (ATT) (range: -3-3).
Percentage Change in Multimedia Situation Test (MST) Scores	before and immediately after the M-TEL intervention	Subjects will undergo the duplicated 15-minute MST tests 15 minutes before the M-TEL intervention with either the IM module or the PPS module and immediately after the M-TEL intervention.
AttrakDiff2 Questionnaire: Hedonic Identification	7 days after the M-TEL intervention	For more delicately evaluate the acceptance of technical innovations, we will assess user experience using the AttrakDiff2. AttrakDiff2 is developed as a tool by Hassenzahl's research group to be able to quantify attractive, identifiable, stimulating, and pragmatic qualities. The tool consists of 28 seven-step items whose poles are opposite adjectives (e.g. confusing - clear, unusual - ordinary, good - bad). Each set of adjective items is ordered into a scale of intensity. Each of the mean values of an item group creates a scale value for pragmatic quality (PQ), hedonic stimulation (HQ-S), hedonic identification (HQ-I), and attractiveness (ATT) (range: -3-3).
AttrakDiff2 Questionnaire: Attractiveness	7 days after the M-TEL intervention	For more delicately evaluate the acceptance of technical innovations, we will assess user experience using the AttrakDiff2. AttrakDiff2 is developed as a tool by Hassenzahl's research group to be able to quantify attractive, identifiable, stimulating, and pragmatic qualities. The tool consists of 28 seven-step items whose poles are opposite adjectives (e.g. confusing - clear, unusual - ordinary, good - bad). Each set of adjective items is ordered into a scale of intensity. Each of the mean values of an item group creates a scale value for pragmatic quality (PQ), hedonic stimulation (HQ-S), hedonic identification (HQ-I), and attractiveness (ATT) (range: -3-3).
AttrakDiff2 Questionnaire: Hedonic Stimulation	7 days after the M-TEL intervention	For more delicately evaluate the acceptance of technical innovations, we will assess user experience using the AttrakDiff2. AttrakDiff2 is developed as a tool by Hassenzahl's research group to be able to quantify attractive, identifiable, stimulating, and pragmatic qualities. The tool consists of 28 seven-step items whose poles are opposite adjectives (e.g. confusing - clear, unusual - ordinary, good - bad). Each set of adjective items is ordered into a scale of intensity. Each of the mean values of an item group creates a scale value for pragmatic quality (PQ), hedonic stimulation (HQ-S), hedonic identification (HQ-I), and attractiveness (ATT) (range: -3-3).

Participant flow

Recruitment details

A total of 60 consecutive volunteers were recruited from a teaching clinic for the validation study from November 23, 2016 to July 5, 2017.

Pre-assignment details

All of the volunteers had at least a basic level of computer literacy, and they were shown the practical aspects of using tablets and applications. The inclusion criteria were as follows: 1) age \>20 years; and 2) undergraduate medical students (clerkship). The exclusion criteria were: 1) previous ORL-HNS training; and 2) declining to participate.

Participants by arm

Arm	Count
Interactive Multimedia Module Subjects allocated to this experimental group will receive an intervention of mobile technology of e-learning (M-TEL) using the interactive multimedia (IM) module consist of integrated text, images, and small game tests (intervention) for 100 minutes. The module is a non-linearity of learning with interaction (student-based choice and pop-up feedback). This context has been adjusted to the same level to that of the PPS module. mobile technology of e-learning (M-TEL): UME students learn the Top 10 emergent ORL-HNS disorders using the M-TEL including the IM module or the PPS module.	30
Power Point Show Module Subjects allocated to this experimental group will receive an intervention of mobile technology of e-learning (M-TEL) using the Power Point show (PPS) module consist of integrated text, images, and audio (intervention) for 100 minutes. The module is a linear learning without interaction. This context has been adjusted to the same level to that of the IM module. mobile technology of e-learning (M-TEL): UME students learn the Top 10 emergent ORL-HNS disorders using the M-TEL including the IM module or the PPS module.	30
Total	60

Baseline characteristics

Characteristic	Total	Interactive Multimedia Module	Power Point Show Module
Age, Continuous	23 years	23 years	23 years
Race and Ethnicity Not Collected	0 Participants	—	—
Sex: Female, Male Female	24 Participants	10 Participants	14 Participants
Sex: Female, Male Male	36 Participants	20 Participants	16 Participants
The cognitive style was assessed using the 25-item group embedded figures test after enrollment.	17 units on a scale	18 units on a scale	17 units on a scale

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk
deaths Total, all-cause mortality	0 / 30	0 / 30
other Total, other adverse events	0 / 30	0 / 30
serious Total, serious adverse events	0 / 30	0 / 30

Outcome results

Primary

Percentage Change in Multiple-choice Question (MCQ) Scores

Subjects will undergo the duplicated 15-minute MCQ tests before after the M-TEL Subjects will undergo the duplicated 15-minute MCQ tests 15 minutes before the M-TEL intervention with either the IM module or the PPS module and immediately after the M-TEL intervention.

Time frame: before and immediately after the M-TEL intervention

Arm	Measure	Value (MEDIAN)
Interactive Multimedia Module	Percentage Change in Multiple-choice Question (MCQ) Scores	40 percentage of MCQ change
Power Point Show Module	Percentage Change in Multiple-choice Question (MCQ) Scores	45 percentage of MCQ change

Secondary

AttrakDiff2 Questionnaire: Attractiveness

For more delicately evaluate the acceptance of technical innovations, we will assess user experience using the AttrakDiff2. AttrakDiff2 is developed as a tool by Hassenzahl's research group to be able to quantify attractive, identifiable, stimulating, and pragmatic qualities. The tool consists of 28 seven-step items whose poles are opposite adjectives (e.g. confusing - clear, unusual - ordinary, good - bad). Each set of adjective items is ordered into a scale of intensity. Each of the mean values of an item group creates a scale value for pragmatic quality (PQ), hedonic stimulation (HQ-S), hedonic identification (HQ-I), and attractiveness (ATT) (range: -3-3).