Cardiac Rehabilitation, Medical Education
Conditions
Keywords
Cardiology residency, Blended learning, Case-based learning, Mini-CEX, DOPS, Cardiopulmonary exercise testing
Brief summary
This randomized controlled trial compares supervised hospital-based practice with matched online activities as part of a common cardiac rehabilitation curriculum for cardiology residents. Ninety-eight residents will be allocated 1:1 to a blended group or an online control group. Both groups will receive the same seven-module online curriculum and the same total scheduled learning time. The blended group will complete a matched block of in-person practice in the cardiology ward, outpatient clinic, and cardiopulmonary exercise testing laboratory, whereas the control group will complete matched-duration supplementary online activities. The primary outcome is the post-training 25-item cardiac rehabilitation knowledge score adjusted for the baseline score. Key secondary outcomes are Mini-CEX and procedure-specific DOPS scores assessed by assessors blinded to allocation.
Detailed description
The curriculum covers cardiac rehabilitation principles; phase I and phase II rehabilitation; cardiopulmonary exercise testing (CPET) and report interpretation; individualized exercise prescription; medication, exercise, nutrition, psychological care, and smoking-cessation prescriptions; multidisciplinary management; patient communication; and management of exercise-related acute events. Both groups receive the same online course, syllabus, learning objectives, and approximately 12 hours of scheduled learning. The blended group replaces one matched-duration block of supplementary online learning with seven supervised in-person sessions. These sessions involve teaching with real patients who provide separate agreement, standardized cases, CPET reports, simulated acute-event scenarios, and immediate feedback. The control group completes additional online case discussions and structured self-study assignments covering the same modules. Measurements occur at three ordered time points. Before randomization and course access, participants complete baseline information and the fixed 25-item knowledge pretest. Immediately after completion of the 7-week course and before release of assessment results, participants complete the same 25-item knowledge post-test and a separate anonymous learner-reported form. Within 7 days after course completion, two independent assessors blinded to allocation complete the Mini-CEX and DOPS ratings. The primary analysis follows the intention-to-treat principle and uses ANCOVA of the post-training knowledge score adjusted for the baseline knowledge score, with multiple imputation for missing baseline or post-training knowledge outcomes.
Interventions
OTHERCommon online cardiac rehabilitation curriculum
A seven-module online course covering cardiac rehabilitation principles, phase I and II rehabilitation, CPET, exercise prescription, the five prescriptions, multidisciplinary care, and acute-event management.
OTHERMatched supplementary online learning
Additional online case discussion and structured self-study assignments covering the same seven modules and matched in scheduled duration to the blended group's in-person sessions.
OTHERHospital-based case and practice sessions
Seven supervised sessions in the cardiology ward, outpatient clinic, and CPET laboratory. Residents practice assessment, risk stratification, CPET interpretation, individualized exercise prescription, patient education, multidisciplinary planning, and simulated acute-event management with immediate instructor feedback.
Sponsors
Second Affiliated Hospital, Zhejiang University, School of Medicine
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Outcomes Assessor)
Masking description
Residents and instructors cannot be blinded to the educational delivery mode. The two Mini-CEX and DOPS examiners do not participate in teaching and are blinded to group allocation.
Intervention model description
Residents are randomized 1:1 to an online control group or a blended learning group. Both groups receive the same online curriculum and matched total scheduled learning time; the matched supplementary block is delivered online in the control group and as supervised hospital-based practice in the blended group.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Resident physician currently participating in standardized residency training * Undertaking a rotation in the Department of Cardiology * Available to attend the cardiac rehabilitation course and study assessments * Provides written informed consent
Exclusion criteria
* Prior systematic cardiac rehabilitation training * Extensive clinical experience in a dedicated cardiac rehabilitation program * Unable to attend the course at the time eligibility is assessed * Declines participation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Post-training cardiac rehabilitation knowledge score adjusted for baseline | Immediately after completion of the 7-week course | A fixed 25-item multiple-choice examination assesses cardiac rehabilitation fundamentals, phase I rehabilitation, phase II rehabilitation, CPET, exercise prescription, and case-based application. Each correct answer is worth 4 points; total scores range from 0 to 100, with higher scores indicating greater knowledge. The primary estimand is the adjusted between-group difference in the post-training total score from ANCOVA with the baseline total score as a covariate. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mini-Clinical Evaluation Exercise total score | Within 7 days after completion of the 7-week course | Two independent examiners blinded to allocation rate the standard seven Mini-CEX domains: medical interviewing, physical examination, humanistic qualities and professionalism, clinical judgment, counseling and communication, organization and efficiency, and overall clinical competence. Each domain is rated from 1 to 9. Each examiner total ranges from 7 to 63, with higher scores indicating better performance. The analysis score is the mean of the two examiner totals. |
| Procedure-specific Direct Observation of Procedural Skills total score | Within 7 days after completion of the 7-week course | Two independent examiners blinded to allocation rate 11 items in a standardized CPET-to-exercise-prescription workflow: indications and contraindications, informed consent, preparation, CPET workflow, safety monitoring, termination criteria, report interpretation, exercise prescription, acute-event management, teamwork, and overall procedural competence. Each item is rated from 1 to 9. Each examiner total ranges from 11 to 99, with higher scores indicating better performance. The analysis score is the mean of the two examiner totals. |
Countries
China
Contacts
PRINCIPAL_INVESTIGATORYaping Wang
Second Affiliated Hospital, Zhejiang University, School of Medicine
Outcome results
None listed