Objective: The objective of this study is to compare the effectiveness of a "cartoon-style" handout with a "traditional-style" handout in a self-study assignment for preclinical medical students. Methods: Third-year medical students (n ¼ 93) at the Faculty of Medicine Ramathibodi Hospital, Mahidol University, took a pre-learning assessment of their knowledge of intercostal chest drainage. They were then randomly allocated to receive either a "cartoon-style" or a "traditional-style" handout on the same topic. After studying these over a 2-week period, students completed a post-learning assessment and estimated their levels of reading completion. Results: Of the 79 participants completing the post-learning test, those in the cartoon-style group achieved a score 13.8% higher than the traditional-style group (p ¼ 0.018). A higher proportion of students in the cartoon-style group reported reading 75% of the handout content (70.7% versus 42.1%). In post-hoc analyses, students whose cumulative grade point averages (GPA) from previous academic assessments were in the middle and lower range achieved higher scores with the cartoon-style handout than with the traditional one. In the lower-GPA group, the use of a cartoon-style handout was independently associated with a higher score. Conclusions: Students given a cartoon-style handout reported reading more of the material and achieved higher postlearning test scores than students given a traditional handout.

What problem was addressed? Cartoons, or comics, are being used increasingly in medical education. Publishing these on the internet can reduced publication costs and give access to an extremely wide audience. As the popularity of social media increases, these could also be effective platforms for cartoon-based medical learning. One study using cartoons on a website demonstrated an improvement in post-learning test scores of healthcare professionals 1 but, to our knowledge, there are no reports of using graphic-novel cartoons on Facebook to teach a medical topic. What was tried? To evaluate the opinions of readers about this approach, a prospective trial was conducted; "Medical Academic Facilitation using Anthropomorphic Cartoon Illustrations (MAFAI): a pilot study". This was approved by the Ethics Committee of Ramathibodi Hospital, Mahidol University. We created a new non-animated comic-style cartoon aimed at teaching the physiology of breath sounds and their clinical examination. The story line used an anthropomorphic figure depicting a medical student questioning a resident about the physical examination of the lungs. The physiology was described using metaphors, diagrams and speech balloons, with the occasional use of humour for entertainment. The original version consisted of 3-4 panels (boxes) of cartoons per page with 29 pages in total. These were later rearranged into 49 pages to make them more readable. The cartoon was posted on a Facebook webpage in March 2016. (Link: http://tiny.cc/MAFAI_study) The final page encouraged readers to participate in an online survey during a 7-week period. Their personal characteristics, occupation and workplace were collected and a 5-point Likert-scale used to gather qualitative opinions of the cartoons. What lessons were learned? To date the cartoon has reached about 30,000 views, with 161 readers completed the questionnaire. Their mean age was 27.2 (±7.4) years and 60% were female. Most were doctors or medical students (62.7%), followed by nurses and nursing students (19.3%). All respondents were satisfied with our cartoon approach. More than 90% reported that the cartoons attracted their attention as well as helping them to memorize the content, understand the physiology, and improve their approach to conducting a thorough physical examination. The anthropomorphic characters were liked by 78% of the participants, only 10% suggesting that the cartoons would be improved by using human characters. Our cartoon stayed "active" for a short period. A peak of about 10,000 views was reached on the day of publication, falling to 3,000 the following day and fewer than 100 views per day after a week. The prior popularity of the webpage probably played a role in determining these numbers, having 2,856 fans at baseline. The number of participants who thought that cartoon density per page was just right increased from 43% to 67% when the original 29-page cartoon was replaced with the rearranged 49-page version, implying that less content density per page might be better. Our study sh...

Real-time PCR did not increase the yield for rapid diagnosis of TBL.

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