Cognitive Style and Mobile E-Learning in Emergent Otorhinolaryngology-Head and Neck Surgery Disorders for Millennial Undergraduate Medical Students: Randomized Controlled Trial

Li-Ang Lee, Yi-Ping Chao, Chung-Guei Huang, Ji-Tseng Fang, Shu-Ling Wang, Cheng-Keng Chuang, Chung-Jan Kang, Li-Jen Hsin, Wan-Ni Lin, Tuan-Jen Fang, Hsueh-Yu Li, Li-Ang Lee, Yi-Ping Chao, Chung-Guei Huang, Ji-Tseng Fang, Shu-Ling Wang, Cheng-Keng Chuang, Chung-Jan Kang, Li-Jen Hsin, Wan-Ni Lin, Tuan-Jen Fang, Hsueh-Yu Li

Abstract

Background: Electronic learning (e-learning) through mobile technology represents a novel way to teach emergent otorhinolaryngology-head and neck surgery (ORL-HNS) disorders to undergraduate medical students. Whether a cognitive style of education combined with learning modules can impact learning outcomes and satisfaction in millennial medical students is unknown.

Objective: The aim of this study was to assess the impact of cognitive styles and learning modules using mobile e-learning on knowledge gain, competence gain, and satisfaction for emergent ORL-HNS disorders.

Methods: This randomized controlled trial included 60 undergraduate medical students who were novices in ORL-HNS at an academic teaching hospital. The cognitive style of the participants was assessed using the group embedded figures test. The students were randomly assigned (1:1) to a novel interactive multimedia (IM) group and conventional Microsoft PowerPoint show (PPS) group matched by age, sex, and cognitive style. The content for the gamified IM module was derived from and corresponded to the textbook-based learning material of the PPS module (video lectures). The participants were unblinded and used fully automated courseware containing the IM or PPS module on a 7-inch tablet for 100 min. Knowledge and competence were assessed using multiple-choice questions and multimedia situation tests, respectively. Each participant also rated their global satisfaction.

Results: All of the participants (median age 23 years, range 22-26 years; 36 males and 24 females) received the intended intervention after randomization. Overall, the participants had significant gains in knowledge (median 50%, interquartile range [IQR]=17%-80%, P<.001) and competence (median 13%, IQR=0%-33%, P=.006). There were no significant differences in knowledge gain (40%, IQR=13%-76% vs 60%, IQR=20%-100%, P=.42) and competence gain (0%, IQR= -21% to 38% vs 25%, IQR=0%-33%, P=.16) between the IM and PPS groups. However, the IM group had a higher satisfaction score (8, IQR=6-9 vs 6, IQR=4-7, P=.01) compared with the PPS group. Using Friedman's two-way nonparametric analysis of variance, cognitive styles (field-independent, field-intermediate, or field-dependent classification) and learning modules (IM or PPS) had significant effects on both knowledge gain (both adjusted P<.001) and satisfaction (both adjusted P<.001).

Conclusions: Mobile e-learning is an effective modality to improve knowledge of emergent ORL-HNS in millennial undergraduate medical students. Our findings suggest the necessity of developing various modules for undergraduate medical students with different cognitive styles.

Trial registration: Clinicaltrials.gov NCT02971735; https://ichgcp.net/clinical-trials-registry/NCT02971735 (Archived by WebCite at http://www.webcitation.org/6waoOpCEV).

Keywords: cognitive style; e-learning; mobile technology; randomized controlled trial.

Conflict of interest statement

Conflicts of Interest: None declared.

©Li-Ang Lee, Yi-Ping Chao, Chung-Guei Huang, Ji-Tseng Fang, Shu-Ling Wang, Cheng-Keng Chuang, Chung-Jan Kang, Li-Jen Hsin, Wan-Ni Lin, Tuan-Jen Fang, Hsueh-Yu Li. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 13.02.2018.

Figures

Figure 1
Figure 1
Analysis, design, development, implementation, and evaluation (ADDIE) model for designing effective instruction of mobile technology in electronic learning (e-learning).
Figure 2
Figure 2
Start of the apps. Learners read the adventure story and objectives (story symbol), played four instructional domains (red arrow symbol), reviewed instructional materials (book symbol), assessed learning progress (bar chart symbol), and got the helps (hint symbol) on the start screen.
Figure 3
Figure 3
Screenshots of the interactive multimedia module. Learners arbitrarily operated a leading character to run, jump, and interact with other nonplayer characters (up) to procure instructional materials (middle). After a small session, learners need to complete small game-based quizzes (low).
Figure 4
Figure 4
Screenshots of the PowerPoint Show module. Learners watched 10 visual-auditory text-image videos of emergent otorhinolaryngology-head and neck surgery (ORL-HNS) disorders. The instructional slides of this module were identical to those of the interactive multimedia module and arranged linearly.
Figure 5
Figure 5
The Consolidated Standards of Reporting Trials flow diagram.

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