Comparing Blended Learning with Faculty-Led Ultrasound Training: Protocol for a Randomised Controlled Trial (The SIGNATURE Trial)

Abstract

Abstract. Background: Ultrasound is increasingly used in clinical practice as a bedside tool. As medical graduates first encounter the technique in early residency, ultrasound training needs to be integrated into the undergraduate curriculum. In Switzerland, abdominal ultrasound skills have been taught by a faculty-led, 21-hour course. However, this course does not have sufficient capacity to meet the increasing demand, and there have been doubts about its effectiveness as a teaching method. We therefore developed a 21-hour blended-learning course, comprising five hours of e-learning and 16 hours of near-peer tutoring. This study investigates whether this new teaching format is as good as, or superior to, the faculty-led method. Methods: The SIGNATURE study is an investigator-initiated, two-arm, randomised controlled trial, enrolling 152 medical students at the Universities of Bern, Fribourg and Zurich. Stratified by study site, students are 1:1 randomised to either the blended-learning course or the faculty-led 2.5-day ultrasound course. Students undergo a six-station objective structured clinical examination (OSCE) and complete an online questionnaire immediately after the course and 6 months later. Discussion: If demonstrated to be effective, the blended-learning course would allow an increase in the number of undergraduate medical students that can acquire ultrasound skills before starting their residencies.

Advances in e-learning in undergraduate clinical medicine: a systematic review

“…More than half of the studies were conducted in the European Union (21 studies). Several research designs were described, including 17 observational studies [25,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42], 13 randomised control trials [26,[43][44][45][46][47][48][49][50][51][52][53][54], three non-randomised control trials [55][56][57], eight qualitative studies [58][59][60][61][62][63][64][65], and one mixed methods study [66]. Thirteen of the total studies included data collection both pre-and post-intervention [25,27,31,34,36,38,…”

“…Thirteen of the total studies included data collection both pre-and post-intervention [25,27,31,34,36,38,39,45,48,[52][53][54]61]. Six studies had follow-up data (collected weeks to months after intervention) [34,45,49,52,54,56] and twelve papers reported ethical approval [28-31, 33, 34, 39, 40, 42, 46, 49, 54]. Furthermore, eight studies described learning theories in the development or evaluation of medical curricula [29,30,33,49,51,52,56,58].…”

“…3. In terms of cognitive domain, 27 interventions were in the domain of knowledge [25-27, 29, 30, 32-35, 39, 40, 42, 43, 47, 48, 50, 52-54, 57, 60-64, 66, 67]; eight were in the domain of skills [9,30,31,36,37,46,49,51] and seven in combined knowledge and skills [38,41,44,45,56,59,65]. The interventions ranged in duration from a single session to a complete academic year.…”

“…Twenty-nine (69%) of the 42 studies described an impact matching a Kirkpatrick level 2, where evaluation of whether learning took place was assessed through post intervention scores [25, 27, 31, 36, 38, 39, 47, 48, 50, 52-54, 56, 57, 61], final exam results [26,29,45,66], direct observation [28,31,33,43,46,51,55] and student survey [25, 26, 30, 37-42, 45, 48, 49, 53, 54, 56, 65, 66]. Among these studies, two studies had included both pre-and post-intervention evaluations but neither had a control group nor longer term follow-up [25,27].…”

“…Learner characteristics identified to enable successful e-learning include: good digital skills, less resistance to change [32] and a willingness to collaborate with peers [66]. Preceptor characteristics were not described in most of the studies, but the role involved guiding students through their learning [33,46,61,66], selection of topics of broad interest to students [60], technical support [54], student evaluation [28,31,37,40,42,45,46,49,51], content development and management [32,41,42,46,54,62] and providing feedback and clear instruction on what is expected of the learners [28,37,40,42,51,54,60].…”