Blended learning in Medical Imaging pre-clinical skills training – does it work?

Vicki Braithwaite, Therese Gunn, Kelly Wilson-Stewart

Introduction The effectiveness of utilising quality blended learning techniques in course delivery within health care education has been well documented. Studies indicate that students react positively to blended learning platforms [1, 2], and that student outcomes are improved [3, 4]. It has been shown that preclinical student confidence can be increased by supplementing more traditional forms of face to face teaching and practical sessions with mixed method options such as self-directed learning tasks and virtual simulation software [5]. As Medical Imaging students progress through their course they become more familiar with the professional environment through their clinical placements, this makes it easier for them to contextualise theoretical content into information that is relevant to their professional practice. First year students may have had little or no exposure to the clinical setting and developing appropriate manual clinical skills for application during clinical practice presents challenges for teaching staff [6, 7]. There is a lack of available evidence on the success of using a blended learning approach to teach preclinical undergraduate Medical Imaging students basic clinical skills.

Background The blended learning environment utilised to support and promote clinical confidence include both digital options and the traditional face to face format. The core skill development for clinical radiography is undertaken in two co-units during the 2nd semester of their first year. During these units, students have access to the following tools; • theoretical lectures (2 x 1 hr per week (pw)) • clinical scenario tutorials (2 hrs pw) • Simulation laboratory, incorporating roleplay and imaging (2 x 1.5hrs pw) • virtual simulation laboratory (1 x 2 hr pw) • self-directed learning

References 1. Kiviniemi, M.T., Effects of a blended learning approach on student outcomes in a graduate-level public health course. BMC MEDICAL EDUCATION, 2014. 14(1): p. 47-47. 2. Maresca, C., et al., Utilization of blended learning to teach preclinical endodontics. Journal of dental education, 2014. 78(8): p. 1194-1204. 3. Pereira, J.A., et al., Effectiveness of using blended learning strategies for teaching and learning human anatomy. Medical Education, 2007. 41(2): p. 189-195. 4. Bains, M., et al., Effectiveness and acceptability of face‐to‐face, blended and e‐learning: a randomised trial of orthodontic undergaduates. European Journal of Dental Education, 2011. 15(2): p. 110-117. 5. Wilson-Stewart, K., V. Braithwaite, and T. Gunn, Benefits of blended learning for the first year medical imaging students in preparation for clinical placement, in 20th Asia Australasia Conference of Radiological Technologists. 2015: Singapore. 6. Funke, K., et al., Blended learning in surgery using the Inmedea Simulator. Langenbeck's Archives of Surgery, 2013. 398(2): p. 335-340. 7. Swamy, M., et al., Role of SimMan in teaching clinical skills to preclinical medical students. BMC medical education, 2013. 13(1): p. 20.

Methods Students were surveyed pre-clinical placement, and again following their orientation 2 week clinical block. The survey was in the form of a Likert Scale and examined the perceived usefulness of the various learning tools in their preparation for confident performance during clinical placement. Students were also assessed during their semester, prior to their clinical placement to discern their learning style(s); further study is to be undertaken on whether this has impact upon their perceived usefulness of various learning tools. Figure 1: VARK Results

Results

Discussion Based on these results, acknowledging the small sample study, engagement within the clinical environment alters the students’ perceptions on the effectiveness of the varying learning tools. 100% of the surveyed students have realised the value roleplay simulation has on their connectedness whilst on clinical placement. It is also important to highlight the benefit of the tutorial engagement demonstrated slight improvement. This could be correlated to the strong focus tutors direct towards effective patient communication skills, and the 'real-world' case studies that formed the basis of the student learning from these tasks. Both these learning tools focus on the communication and interaction of the student radiographers. Interestingly, on reflection post clinical placement, the technical proficiency tools, the phantoms and the virtual simulation both decrease in perceived effectiveness. The authors conclude that these students have learnt the technical “text-book” positioning of the phantoms and virtual environment, but on clinical, these patients are few and far between. The adaptation of technique is a skill learnt within the clinical environment and discussed in later years within the undergraduate curriculum.

Conclusion Data obtained for this study can be further analysed correlating individual student responses pre and post clinical as well as investigation into each student’s learning style. As part of a wider study, these students accessed an on-line questionnaire to survey their individual learning style. Further analysis of these results, coupled with the conclusion of students’ perceived benefits to the “soft skill” learning tools for clinical practice, poses further research questions into the way our students engage with the different approaches to learning and the anticipation of innovative learning design to achieve this.

Figure 2: Student tool perceptions

Students surveyed both prior (n=35) and post (n = 32) their clinical placement. Students were asked to rate their perceived usefulness of using a variety of learning tools in their learning. Students perceived both simulation laboratory experiences were the most effective tools in their learning both pre and post clinical. 94.12% (n=32) of the students realising the value of performing role-play simulation prior to clinical placement, with 100% (n=32) post clinical, whereas the x-raying of disarticulated phantoms in the simulated radiographic laboratory was perceived to be 100% (n=35) prior to clinical with a drop to 68.75% post clinical. 85.71% (n=30) students agreed or strongly agreed prior to clinical that tutorial engagement was useful with 87.5% (n=28) post clinical. Interestingly, self-directed/reflective learning yielded 62.85% (n=22) prior to clinical with a decrease to 46.88% (n=15) post. The virtual simulation laboratory was perceived to be the least useful with only 25.72% (n=9) perceiving the value and 25% (n=8) post.

Visual (20%)

Aural (11%)

Read/Write (36%)

Kinesthetic (33%)

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Roleplay Phantoms Tutorial Self/Reflective Virtual Sim

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Acknowledgement: We would like to thank Queensland University of Technology staff and students for their assistance with our research.