A three-arm single blind randomised control trial of naïve medical students performing a shoulder joint clinical examination

Abstract

Background Technological advances have previously been hailed as a new dawn in Higher Education, with the advent of ‘massive open online courses’ (MOOCs) and online learning. Virtual platforms have potential advantages such as accessibility and availability but simply transferring educational material to the online environment may not ensure high quality learning. Clinical examination is a fundamental principle of medical assessment, and this study aimed to assess the role of technology in teaching these skills. Aims/objectives To determine whether three teaching modalities were of equal efficacy in teaching examination of the shoulder joint to naïve medical students. Methods Sixty-seven pre-clinical medical students naïve to large joint examination were recruited. Participants completed a learning style questionnaire and were then block randomised to three study: textbook study, face-to-face seminar, or video tutorial via online platform. The same examination technique was taught in all groups, with the intervention being the method of delivery All second year students were eligible for inclusion. The single exclusion criteria was previous exposure to clinical examination teaching. Students were assessed using a standardised scoring system at baseline (pre-intervention), and days 5 and 19 post-intervention (maximum score 30). Assessors were blinded to group allocation. The primary outcome was assessment score at day 5 post intervention. Results There was no difference between the three groups at baseline assessment (mean scores 2.4 for textbook, 2.8 for face-to-face, and 3.1 for video; p = 0.267). Mean post-intervention scores were 16.5 textbook, 25.5 face-to-face, and 22.4 video (p < 0.001, η2 = .449). There was no change between day 5 and day 19 post-intervention assessment scores in any group (p = 0.373), Preferred learning style did not affect scores (p = 0.543). Conclusion Face-to-face teaching was the most effective method for teaching clinical examination of the shoulder. Technology can potentially increase accessibility and remove geographic barriers, but is not as effective if teaching techniques are simply mirrored in an online format. Online platforms allow in depth data analysis of how learners interact with educational material and this may have value in improving the design of online educational materials, and is a potential area for further research.

Learning Design Strategies in MOOCs for Physicians’ Training: A Scoping Review

“…Taken together, these findings suggest investigating further factors able to shape the learning outcomes of MOOCs. In line with Alario-Hoyos et al [99], it is plausible to suppose that an explanation for the findings of Brewer et al [76] might be found in the characteristics adopted to build their MOOC. It was developed through a mere replication of a textbook diagnostic chapter with no care for the distinctive aspects of MOOC "language", such as its multimodal or interactive dimensions, as previously mentioned.…”

“…Studies included in this area [ 76 , 77 , 78 ] compared the MOOC teaching model and the traditional educational ones.…”

“…The study by Brewer et al [ 76 ] compared the learning outcomes of three modalities in teaching clinical examination: MOOC, face-to-face education, and a textbook chapter. The latter contained both written and pictorial descriptions of a standardized approach to the examination of shoulders, while the MOOC consisted of a video showing a physician teaching the same comprehensive examination described within the textbook; in the face-to-face teaching session, a physician taught a shoulder examination following the method adopted both in the textbook chapter and the custom video.…”

“…Surprisingly, the studies included in the current review seem to partially challenge these findings. More precisely, Brewer et al [ 76 ] documented better learning outcomes in the experimental group with traditional face-to-face training than in the MOOC group. However, in contrast to this result, Wang et al [ 78 ] demonstrated the potential of the MOOC model to lead to higher learning performance and satisfaction levels than traditional education when it is combined with the flipped classroom approach.…”

Can educational video resources improve learning when used to augment traditional teaching of clinical examination? A randomized control trial of novice medical students

“…In a recent randomised control trial performed by our group (Brewer at al. 2021) it was demonstrated that face-to-face teaching was superior to both text-book learning and video learning in teaching clinical examination of the shoulder joint [ 7 ].…”