Juniper Publishers: E-Learning in Gynecologic Oncology for Obstetrics and Gynecology Residents
JUNIPER PUBLISHERS- JOURNAL OF GYNECOLOGY AND WOMEN’S
HEALTH
Journal of Gynecology and Women’s Health-Juniper
Publishers
Authored by Laurie Elit*
Objective: To determine the
feasibility of creating and implementing an elearning module in a high
and low resource setting Obstetrics and Gynecology residency program.
Method: An elearning module focused
on Gestational Trophoblastic Disease (GTD) was created. Surveys
assessing, readability, resident satisfaction with design and layout and
content were conducted.
Outcomes: Thirty out a possible 41
residents in Georgetown, Guyana and Hamilton, Canada provided feedback
on the module. (80% return rate). 79% of Guyanese and 75% of Canadian
residents felt the GTD elearning module to be effective was effective in
enhancing their learning.
Conclusion: e-learning can be used
as a supplemental technique to enhance learning in gynecologic oncology
residency programs. This has been evaluated in both a low and high
resource setting with similar feedback.
Introduction
Online learning or e-learning is an educational
approach that can be utilized to supplement traditional classroom
teaching styles [1].
It has been widely accepted across many secondary school districts in
an attempt to fill in curricular gaps and enhance student learning [1]
but, is yet to be added as a mandatory component of the medical school
curriculum. This particular report will discuss the effectiveness of
e-learning as a supplemental learning tool for resident OB/GYN students
in Southern and Northern America, Georgetown, Guyana and Hamilton,
Ontario, respectively. Conclusions will be drawn from a short assessment
survey that residents completed after watching an e-learning module on
Gestational Trophoblastic Disease (GTD).
Methods
A needs assessment questionnaire was distributed to
41 residency directors and educators across Canada. The results revealed
that there are a limited number of resident educators using e-learning
in their OB/GYN programs, but, of the 5 responders who indicated use of
e-learning modules, the majority of them found it to be an effective
supplementary learning modality (scoring 6-8 out of 10 on a likert
scale) [2].
After making this conclusion, an e-learning module on
GTD was developed to educate residents on the prevalence of the
disease, its complexity and treatment. The module is composed of
learning objectives which include: 1) the ability to properly diagnose a
patient using patient history, physical examinations, lab-tests, and
radiological investigations 2) differentiate between high- and low-risk
diseases and 3) describe the different treatment options and their
effectiveness. The module also includes a pre-test that is designed to
establish the resident’s foundational knowledge on the subject; the core
content which is presented in an engage/interactive format with each
slide building off of the previous one; a case study that is presented
halfway through the module and includes multiple choice questions to
assess knowledge attainment; and finally, a post-test that is used to
determine resident comprehension of the module content. Upon completing
the module, 3 gynecologic oncologists provided feedback on its content
and structure. Amendments were made and the module was inputted into an Articulate software program. At this point, the module was released online to be assessed by residents.
To determine the effectiveness of e-learning as a
supplemental learning tool for OB/GYN residents, a survey evaluating the
use of e-learning was developed. The survey was composed of 19
questions and was distributed to residents from one OB/GYN program in
South America and one in North America. The survey used a variety of
question types in order to receive constructive feedback from residents.
The survey questions include: multiple choice, list (radio), Array (10
point likert scale), Array (5 point likert scale), yes/no, and long free
text questions. These question types were used to assess the GTD
module’s readability and resident satisfaction with the design and
layout of the module and its content. Residents from both jurisdictions
were able to watch the module online. Residents from South America were
able to view the module through a large TV screen in a classroom
setting. Residents from North America used their personal computers to
view the module. Participants from South America completed the survey by
hand and those from North America accessed the survey via weblink.
In 2012, Dr. Margaret Larkins-Pettigrew and Tia
Melton initiated the Women, Neonates, Diversity, Outreach, Opportunities
and Research Program (WONDOOR) [3]. This program entails a four-year degree that is designed to educate and train OB/GYN residents in global health [3].
The program is organized so that an attending physician visits Guyana
for one week per month to educate residents through the use of a themed
module that caters to their desired specialty or interest [3].
Since. Since module directed education has already been implemented in
the structure of the WONDOOR OB/GYN education program, additional
modules on OB/GYN topics that are accessible to the residents at their
convince could provide a valuable educational resource.
The OB/GYN residency program at McMaster University
located in Hamilton, Ontario differs from the OB/GYN program at
Georgetown Public Hospital in that it is a five-year residency program [4]. Additionally, resident education is designed to be “problem-centered and experience based [4].” Residents begin the program under heightened faculty supervision [4].
As their skills develop and they evolve as physicians, the level of
supervision decreases and they become predominately independent. Where
the WONDOOR’s OB/GYN program is structured to teach residents
didactically, McMasters OB/GYN program is focused on self-directed,
hands-on learning. With that being said, nearly all McMaster residents
who took part in the survey have been exposed to e-learning and the
overall impression is that it has been a useful educational resource to
rely on for supplemental information.
Results
Out of 21 responders, 14 residents from South America
completed the survey in full, yielding a return rate of 67%. From the
pool of North American residents, 16 out of a possible 20 participants
answered all of the survey questions which resulted in a return rate of
80%. In comparing responses from both districts, 43% of the participants
from South America were level-1 residents while the survey participants
from North America were distributed evenly between level-2, level-3,
level-4, and level-5 of the residency program with 25% of the survey
population representing each level, except level-1. 86% of the South
American participants and 75% of the North American participants stated
that the module took no longer than 60 minutes to complete. This
includes the time it took the residents to complete the pre- and post-
test multiple choice questions (MCQ) (8 pre-test questions and 10
post-test questions).
79% (scores 7-10 out of 10) of South American
participants and 75% (scores 7-9 out of 10) of the North American
participants stated that the GTD e-learning module was effective in
enhancing their learning experience.
On a scale from 1 (poor) to 5 (excellent) 71% of the
South American participants stated that the concepts covered in the
e-learning module were easy to understand (rated 5 out of 5). 88% of the
North American participants gave the e-learning module a rating of 4 or
5 out of 5 for concept comprehension. Therefore, it is reasonable to
assume that the questions assessing the module content were transparent
and that the residents were confident in their knowledge of the content
and in their ability to solve the presented problems [5].
Across both districts nearly all participants stated that they would
prefer that the e-learning module concepts covered in this module be
taught through a combination of e-learning and didactic teaching (e.g.
module as pre-homework). As mentioned previously, a “blended” teaching
style has positive outcomes associated with student learning. Three out
of 14 residents from South America stated that they [1]
had no experience with e-learning while all residents from North
America who responded to the survey had a previous and similar
experience with e-learning. Despite the fact that residents from South
America are working in low resource settings the majority of them are
still able to access online resources such as e-learning modules.
Therefore, one can conclude that e-learning modules are an accessible
supplemental learning tool for all residents.
In terms of knowledge acquisition, didactic teaching
was the most beneficial aspect of the module for South American
residents while the case study was the most beneficial aspect for North
American residents. Additionally, both the pre- and post-tests were
marked valuable by the majority of residents from both districts.
Providing residents with a case study and MCQ’s gives them the
opportunity to apply the knowledge they learned in the content section
of the module to ‘real world’ situations. Furthermore, it allows them to
utilize their problem solving skills, which gives the content they
learned some context for application in a clinical setting as they have
to determine the cause of the proposed problem and devise a solution [6].
86% of participants from both districts rated their overall experience
with this e-learning module as being satisfactory or excellent. One
aspect of the module deemed least beneficial to knowledge acquisition
by both populations was the use of a narrator for the module content.
This claim holds merit in that the instructor dictating the module
content spoke at variable volumes throughout the module.
Discussion
The GTD module was pilot tested in Guyana to take
into account the barriers to implementing a supplemental learning tool
in an under serviced area. The barriers to implementation include
limited access to the internet and language barriers. The results from
the pilot test in Guyana were compared to the results from the pilot
test in Hamilton, a city with adequate resources, to assess the
difference in how the module was received in both populations. Overall,
the results were similar in that both resident groups had similar
previous experiences with e-learning and were quite satisfied with the
delivery of the module, its content, and content assessment method
(predominantly MCQ’s).
Er, Ramamurthy, and Pook state that cognitive skills can be assessed effectively through the use of high quality MCQ [6].
Not only are MCQ’s an effective assessment tool, they are also
efficient in that they cover a large amount of content in a short period
of time [6].
Therefore, the use of MCQ’s within the e-learning module is ideal to
ensure that the module can be completed in a timely fashion.
Thrasher, Coleman, and Atkinson compared the
effectiveness of face-to-face training to web-based training, and
blended training (a combination of face-to-face and web-based training)
to determine its effect on declarative and procedural knowledge [7].
They concluded that web-based training was more effective than
face-to-face training in acquiring “know that” knowledge and was equal
to teacher-led training of “know how” knowledge [7]. Additionally, the blended training was shown to be more effective for both kinds of learning [7].
This supports the notion that e-learning can be used to supplement
resident education, effectively. According to Means, Bakia, and Murphy
online learning can be especially beneficial to knowledge attainment of
challenging content [8].
In the case of GTD, its diagnosis is quite rare with gestational
trophoblastic neoplasia developing in 15% of women who have had a molar
pregnancy, choriocarcinoma occurring in 1 in 40,000 pregnancies, and
placental site trophoblastic tumor and epithelioid trophoblastic tumor
making up only 0.2% of all cases of GTD [9].
Conclusion
While there were some technical difficulties with the
computation of the module, the overall consensus is that the pilot test
was successful. Nearly 100% of the survey population claimed that they
would prefer to use e-learning as a supplemental learning modality in
conjunction with traditional teaching styles instead of using e-learning
or teacher-led instruction alone. The evaluation of e-learning to
augment education is an important area of research and development that
holds great potential for future exploration.
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