Cognitive Style and Mobile Technology in E-learning in Undergraduate Medical Education

Cognitive Style and Mobile Technology in E-learning in Undergraduate Medical Education- A Randomized Controlled Trial of Otolaryngology-head and Neck Surgery

New designs of 6-year undergraduate medical education (UME) in Taiwan mainly include (1) integral curricula of body organ system, (2) multiple methods of clinical teaching and assessment, and (3) generalism in UME. Accompany with decreasing educational hours in the classrooms and hospital, essential but minor components of primary healthcare such as ophthalmology and otolaryngology-head and neck surgery (ORL-HNS) is disproportionately under-represented in UME. Novel medical education stresses on enabling self-directory learning and increasing learning hours outside the classrooms. Accordingly, we hypothesize that innovations in educational technology can enhance the learning outcomes of ORL-HNS. This study is aimed to determine whether mobile technology in e-learning (M-TEL) is an effective tool for the instruction of ORL-HNS and to compare effects of different cognitive styles on learning outcomes of M-TEL with various modules of medical education. This is a randomized controlled trial. We will recruit 60 UME students without previous training in ORL-HNS to undergo the Group Embedded Figures Test to determine their cognitive styles such as field dependence or field-independence. After blinded randomization, students are instructed on two modules of emergent ORL-HNS disorders, using either a standard e-learning of text-figure Power Point show or an interactive multimedia module. Subjects are evaluated on emergent ORL-HNS disorders using text-based assessment and multimedia assessment take place prior to and following instruction. After 7 days later, they will be assessed using global satisfaction score and AttrakDiff2 questionnaire. We anticipate that this study can confirm M-TEL can enhance the efficiency of the instruction of ORL-HNS and understand differences in learning outcomes of M-TEL with various modules of medical education between field dependence and filed independence using this platform.

Study Overview

• Status: Completed
• Conditions: Medical Education
• Intervention / Treatment: Other: mobile technology of e-learning (M-TEL)

Detailed Description

Background:

New designs of 6-year undergraduate medical education (UME) mainly include (1) integral curricula of body organ system, (2) multiple methods of clinical teaching and assessment, and (3) generalism in UME. UME is meant to enable graduates to become undifferentiated general physicians. Accompany with decreasing educational hours in the classrooms and hospital, essential but minor components of primary healthcare such as ophthalmology and otolaryngology-head and neck surgery (ORL-HNS) is disproportionately under-represented in UME. In Canada, substantial downstream effects on managing ORL-HNS problems have been noted in family medicine residents. In order to improve learning insufficiency and enhance clinical competency without increasing extra-hours in the classrooms and hospitals, novel medical education stresses on enabling self-directory learning and increasing learning hours outside the classrooms. Accordingly, we hypothesize that innovations in educational technology can enhance the learning outcomes of ORL-HNS.

Purposes: This study is aimed to determine whether mobile technology in e-learning (M-TEL) is an effective tool for the instruction of ORL-HNS and to compare effects of different cognitive styles on learning outcomes of M-TEL with various modules of medical education.

Material and Methods:

This is a randomized controlled trial. Firstly, we have been setup a e-learning platform of the Top 10 emergent ORL-HNS disorders with translating into an application (APP) function that can execute in mobile devices. Secondly, we will recruit 60 UME students without previous training in ORL-HNS to undergo the Group Embedded Figures Test to determine their cognitive styles such as field dependence or field-independence. After blinded randomization, students are instructed on two modules of emergent ORL-HNS disorders, using either a standard e-learning of text-figure Power Point show or an interactive multimedia module. Subjects are evaluated on emergent ORL-HNS disorders using a text-based assessment and a multimedia assessment take place prior to and following instruction.

Anticipating Outcome:

This study can (1) establish a M-TEL of ORL-HNS that can deliver an innovatively mobile e-learning to supplement the deficiency of the classroom hours, (2) confirm M-TEL can enhance the efficiency of the instruction of ORL-HNS, and (3) understand differences in learning outcomes of M-TEL with various modules of medical education between field dependence and filed independence using this platform.

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Age > 20 years old;
2. UME students (defined as the three or four years of medical school training).

Exclusion Criteria:

1. Previous ORL-HNS training;
2. Declining to participate.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: interactive multimedia module; Subjects allocated to this experimental group will receive an intervention of mobile technology of e-learning (M-TEL) using the interactive multimedia (IM) module consist of integrated text, images, and small game tests (intervention) for 100 minutes. The module is a non-linearity of learning with interaction (student-based choice and pop-up feedback). This context has been adjusted to the same level to that of the PPS module.	Other: mobile technology of e-learning (M-TEL); UME students learn the Top 10 emergent ORL-HNS disorders using the M-TEL including the IM module or the PPS module.
Active Comparator: Power Point show module; Subjects allocated to this experimental group will receive an intervention of mobile technology of e-learning (M-TEL) using the Power Point show (PPS) module consist of integrated text, images, and audio (intervention) for 100 minutes. The module is a linear learning without interaction. This context has been adjusted to the same level to that of the IM module.	Other: mobile technology of e-learning (M-TEL); UME students learn the Top 10 emergent ORL-HNS disorders using the M-TEL including the IM module or the PPS module.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage Change in Multiple-choice Question (MCQ) Scores	Subjects will undergo the duplicated 15-minute MCQ tests before after the M-TEL Subjects will undergo the duplicated 15-minute MCQ tests 15 minutes before the M-TEL intervention with either the IM module or the PPS module and immediately after the M-TEL intervention.	before and immediately after the M-TEL intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage Change in Multimedia Situation Test (MST) Scores	Subjects will undergo the duplicated 15-minute MST tests 15 minutes before the M-TEL intervention with either the IM module or the PPS module and immediately after the M-TEL intervention.	before and immediately after the M-TEL intervention
Global Satisfaction Score	Global satisfaction score is measured using a visual analogue scale from 0 (very dissatisfied) to 10 (very satisfied) after 7 days post M-TEL.	7 days after the M-TEL intervention
AttrakDiff2 Questionnaire: Pragmatic Quality Score	For more delicately evaluate the acceptance of technical innovations, we will assess "user experience" using the AttrakDiff2. AttrakDiff2 is developed as a tool by Hassenzahl's research group to be able to quantify attractive, identifiable, stimulating, and pragmatic qualities. The tool consists of 28 seven-step items whose poles are opposite adjectives (e.g. "confusing - clear", "unusual - ordinary", "good - bad"). Each set of adjective items is ordered into a scale of intensity. Each of the mean values of an item group creates a scale value for pragmatic quality (PQ), hedonic stimulation (HQ-S), hedonic identification (HQ-I), and attractiveness (ATT) (range: -3-3).	7 days after the M-TEL intervention
AttrakDiff2 Questionnaire: Hedonic Stimulation	For more delicately evaluate the acceptance of technical innovations, we will assess "user experience" using the AttrakDiff2. AttrakDiff2 is developed as a tool by Hassenzahl's research group to be able to quantify attractive, identifiable, stimulating, and pragmatic qualities. The tool consists of 28 seven-step items whose poles are opposite adjectives (e.g. "confusing - clear", "unusual - ordinary", "good - bad"). Each set of adjective items is ordered into a scale of intensity. Each of the mean values of an item group creates a scale value for pragmatic quality (PQ), hedonic stimulation (HQ-S), hedonic identification (HQ-I), and attractiveness (ATT) (range: -3-3).	7 days after the M-TEL intervention
AttrakDiff2 Questionnaire: Hedonic Identification	For more delicately evaluate the acceptance of technical innovations, we will assess "user experience" using the AttrakDiff2. AttrakDiff2 is developed as a tool by Hassenzahl's research group to be able to quantify attractive, identifiable, stimulating, and pragmatic qualities. The tool consists of 28 seven-step items whose poles are opposite adjectives (e.g. "confusing - clear", "unusual - ordinary", "good - bad"). Each set of adjective items is ordered into a scale of intensity. Each of the mean values of an item group creates a scale value for pragmatic quality (PQ), hedonic stimulation (HQ-S), hedonic identification (HQ-I), and attractiveness (ATT) (range: -3-3).	7 days after the M-TEL intervention
AttrakDiff2 Questionnaire: Attractiveness	For more delicately evaluate the acceptance of technical innovations, we will assess "user experience" using the AttrakDiff2. AttrakDiff2 is developed as a tool by Hassenzahl's research group to be able to quantify attractive, identifiable, stimulating, and pragmatic qualities. The tool consists of 28 seven-step items whose poles are opposite adjectives (e.g. "confusing - clear", "unusual - ordinary", "good - bad"). Each set of adjective items is ordered into a scale of intensity. Each of the mean values of an item group creates a scale value for pragmatic quality (PQ), hedonic stimulation (HQ-S), hedonic identification (HQ-I), and attractiveness (ATT) (range: -3-3).	7 days after the M-TEL intervention

Collaborators and Investigators

• Sponsor: Chang Gung Memorial Hospital
• Collaborators: Ministry of Science and Technology, Taiwan
• Investigators: Principal Investigator: Li-Ang Lee, M.D., Chang Gung Memorial Hospital

Publications and helpful links

General Publications

• Glicksman JT, Brandt MG, Parr J, Fung K. Needs assessment of undergraduate education in otolaryngology among family medicine residents. J Otolaryngol Head Neck Surg. 2008 Oct;37(5):668-75.
• Wolff M, Wagner MJ, Poznanski S, Schiller J, Santen S. Not another boring lecture: engaging learners with active learning techniques. J Emerg Med. 2015 Jan;48(1):85-93. doi: 10.1016/j.jemermed.2014.09.010. Epub 2014 Oct 13.
• Yavner SD, Pusic MV, Kalet AL, Song HS, Hopkins MA, Nick MW, Ellaway RH. Twelve tips for improving the effectiveness of web-based multimedia instruction for clinical learners. Med Teach. 2015 Mar;37(3):239-44. doi: 10.3109/0142159X.2014.933202. Epub 2014 Aug 11.
• Alegria DA, Boscardin C, Poncelet A, Mayfield C, Wamsley M. Using tablets to support self-regulated learning in a longitudinal integrated clerkship. Med Educ Online. 2014 Mar 12;19:23638. doi: 10.3402/meo.v19.23638. eCollection 2014.
• Chapman DM, Calhoun JG. Validation of learning style measures: implications for medical education practice. Med Educ. 2006 Jun;40(6):576-83. doi: 10.1111/j.1365-2929.2006.02476.x.
• Lee LA, Wang SL, Chao YP, Tsai MS, Hsin LJ, Kang CJ, Fu CH, Chao WC, Huang CG, Li HY, Chuang CK. Mobile Technology in E-Learning for Undergraduate Medical Education on Emergent Otorhinolaryngology-Head and Neck Surgery Disorders: Pilot Randomized Controlled Trial. JMIR Med Educ. 2018 Mar 8;4(1):e8. doi: 10.2196/mededu.9237.
• Lee LA, Chao YP, Huang CG, Fang JT, Wang SL, Chuang CK, Kang CJ, Hsin LJ, Lin WN, Fang TJ, Li HY. Cognitive Style and Mobile E-Learning in Emergent Otorhinolaryngology-Head and Neck Surgery Disorders for Millennial Undergraduate Medical Students: Randomized Controlled Trial. J Med Internet Res. 2018 Feb 13;20(2):e56. doi: 10.2196/jmir.8987.

Study record dates

Study Major Dates

• Study Start: November 23, 2016
• Primary Completion (Actual): July 5, 2017
• Study Completion (Actual): December 31, 2017

Study Registration Dates

• First Submitted: November 17, 2016
• First Submitted That Met QC Criteria: November 20, 2016
• First Posted (Estimate): November 23, 2016

Study Record Updates

• Last Update Posted (Actual): February 16, 2021
• Last Update Submitted That Met QC Criteria: January 27, 2021
• Last Verified: November 1, 2016

More Information

Terms related to this study

• Keywords: randomized controlled trial; mobile technology; e-learning; cognitive style; otolaryngology-head and neck surgery
• Other Study ID Numbers: 105-5290C

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: The individua participant data of UME students may be not suitable to be available to other researchers