Elsevier

Journal of Surgical Education

Volume 69, Issue 4, July–August 2012, Pages 449-452
Journal of Surgical Education

Original report
Novel Educational Approach for Medical Students: Improved Retention Rates Using Interactive Medical Software Compared with Traditional Lecture-Based Format

https://doi.org/10.1016/j.jsurg.2012.05.013Get rights and content

Background

Mannequin and computer-based simulators are useful for the practice of patient management, physical procedures, and competency. However, they are ineffective in teaching clinical medicine. StepStone Interactive Medical Software (SS) is a web-based medical learning modality that provides the user with a highly focused set of evaluative and interventional tasks to treat memorable virtual patients in a visual case-based format.

Objective

To determine whether the SS learning modality is superior to traditional lecture format in medical student learning and retention.

Methods

After Institutional Review Board (IRB) approval was obtained and the consents were signed, 30 third-year medical students were assigned randomly to 2 groups of 15 students each: The control group received two 30-minute PowerPoint lectures (Microsoft Corporation, Redmond, Washington) about torsades de pointes (TdP) and pulseless electrical activity (PEA), and the SS group was given 1 hour to review 2 SS cases teaching TdP and PEA. A preintervention test was given to assess their baseline knowledge. An immediate postintervention test was given to both groups. Twenty-two days later, a long-term retention test was administered. The results were analyzed using a Student t test for continuous variables.

Results

The mean scores for the preintervention test in the control and SS groups were 44.9 ± 3% and 44.1 ± 2%, respectively (p = 0.41). The mean scores for the postintervention test in the control and SS groups were 61.7 ± 2% and 86.7 ± 2%, respectively (p < 0.001). Improvement from baseline knowledge was calculated, and the mean improvement was 16.8 ± 3% in the control group and 42.5 ± 2% in the SS group (p < 0.001). The long-term retention test revealed the mean scores of 55.8 ± 3% in the control group and 70.1 ± 3% in the SS group (p < 0.001). Long-term improvement from baseline knowledge was calculated and the control group improved by 10.9 ± 4%, whereas the SS group improved by 26 ± 3% (p = 0.002).

Conclusions

The SS learning modality demonstrated a significant improvement in student learning retention compared to traditional didactic lecture format. SS is an effective web-based medical education tool.

Introduction

The current model of American medical education typically consists of 1.5 to 2 years of basic science education followed by 2 to 2.5 years of clinical clerkships. The didactic portion of basic science education is accomplished mainly via classroom-based lectures with laboratory work and problem-based learning modules as complementary measures. Emphasis is placed on basic human anatomy, physiology, and pathophysiology to build a foundation before students enter the wards and clinics. Clinical clerkships consist of rotations through the various medical specialties, such as surgery and internal medicine. The overall goal of the clerkships is to teach diagnosis and management of various disease states through a cognitive apprenticeship model, rather than a lecture-based model, of teaching.

In the cognitive apprenticeship model, students work with an instructor to solve a problem and thereby gain the knowledge needed for independent problem solving.1 During the clerkships, medical students learn by observing patients and are required to read supplementary material on disease processes not observed in the hospital. The students' education is supported by theoretical concepts learned in physiology, pathology, and other basic sciences in their early medical school careers. Through patient encounters, medical learners build mental representations of disease processes, including epidemiology, signs, symptoms, diagnostic studies, and treatment. As the learners gain more experience, they build a library of patients that increases in number and depth over time. This is a prime example of the constructivist theory of learning as an active process that uses facts in context to build knowledge.

The latest theories in neurobiology of learning extol constructivism as the optimal framework for learning.2 This model of teaching, while effective, has a major problem that decreases its utility: The learner must observe and participate in the management of a patient with a particular disease to build the mental representative patient. It can be difficult for learners to construct a representative patient for 3 reasons: Basic learners are much less involved in the management and treatment of acute and life-threatening conditions, some conditions are so rare they may only be seen a handful of times in the clinician's entire career, and the restriction of resident working hours instituted by the Accreditation Council for Graduate Medical Education (ACGME) will result in residents observing fewer patients during their training. Learners are taught management of high-stakes and/or low-incidence diseases through the traditional learning modalities of textbooks and lectures, and it can be assumed that the impending gap in resident–patient interaction will be filled in the same way. As alluded to previously, this is a poor substitute for observing the disease and being involved in the management of patients.

While simulators have a useful place in the practice of physical procedures, practice of patient management, and testing of competency, they are intuitively a poor design for the teaching of clinical medicine. The limitless possibilities of diagnostic and treatment interventions of a simulator allow a novice the freedom to advance into erroneous oblivion while failing to give priority to the appropriate sequence of management. This type of simulation can lead to frustration for those with limited clinical knowledge, which is the audience with the greatest need for this type of learning experience. A more appropriate teaching modality would be one in which a management sequence and thought process is highlighted while giving the user limited choices for intervention within that framework.

StepStone Interactive Medical Software (SS) (StepStone Med, Inc., Houston, Texas) is a web-based medical learning modality that provides the user with a highly focused set of evaluative and interventional tasks to treat memorable virtual patients. Representative patients for each acute condition serve as the patient and professor, paying homage to the widely held belief that patients are our best teachers. A virtual patient provides an engaging and interactive experience in which the learner is the principal decision maker rather than a passive observer. Our objective was to compare the educational outcomes of a group of students learning via traditional didactic lecture with a similar group using the SS virtual patient.

Section snippets

Methods

After approval by the Baylor College of Medicine Institutional Review Board, 33 third-year medical students were consented and randomly assigned to 2 groups: the SS group and a control group. Each medical student had completed 6 months of clinical experience and was beginning the first day of his or her core surgery clerkship. Two PowerPoint (PPT) lectures (Microsoft Corporation, Redmond, Washington) were prepared as the control resources to teach the management of torsades de pointes (TdP) and

Results

The mean scores for the preintervention test in the control and SS groups were 44.9 ± 3% and 44.1 ± 2%, respectively (p = 0.41; Fig. 1). The mean scores for the postintervention test in the control and SS groups were 61.7 ± 2% and 86.7 ± 2%, respectively (p < 0.001). The mean scores of the long-term retention test were 55.8 ± 3% in the control group and 70.1 ± 3% in the SS group (p < 0.001). The difference between the score of each learner's preintervention and postintervention test was

Discussion

A common notion touted by physicians is that medicine is best learned from patients, rather than from books or lectures. Gaps of knowledge exist where patient acuity is so high that the risk posed by learners is unacceptable and where there are no patients from whom to learn. The method for bridging those gaps remains in question. The standard lecture format does not lend itself to learner interactivity or engaging memorable experiences, especially when compared with the unique experience of

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