MicroLearning in Undergraduate Medical Education - KnowledgeFox

Smolle / Bruck | MicroLearning in Undergraduate Medical Education | October 2017

MicroLearning in Undergraduate Medical Education Josef Smolle1) Peter A. Bruck2) 1)

Institut für Medizinische Informatik, Statistik und Dokumentation, Medizinische Universität Graz, Auenbruggerplatz 2/5, 8036 Graz, Austria 2)

Research Studio Austria Forschungsgesellschaft mbH und KnowledgeFox GmbH, Thurngasse 8/20, 1090 Wien, Austria www.knolwledgefox.net

Paper for interactive contribution for Workshop

Technology Enhanced Learning in Health Professions Education: What’s possible now and what does tomorrow hold? i-KNOW Conference 11th October 2017, Graz

Please address comments and correspondence to: Univ.-Prof. Dr. Josef Smolle, Institut für Medizinische Informatik, Statistik und Dokumentation, Medizinische Universität Graz, Auenbruggerplatz 2/5, 8036 Graz, Austria; email: [email protected]

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Abstract MicroLearning is a special type of technology enhanced learning which is characterized among others by contents split into small chunks, the exploitation of mobile handheld devices, and short learning sessions with a maximum of several minutes duration. The Medical University of Graz has launched a MicroLearning project using the commercially available, ready-to-use MicroLearning software KnowledgeFox®. This software capitalizes on the power law of practice, the spacing effect, the testing effect and the multimedia effect, along with active user participation. Up to now, the MicroLearning system of the Medical University of Graz contains more than 8000 learning cards in 334 lessons and 102 courses. Topics comprise histology and embryology, pharmacology, thoracic surgery, and demo lessons of a variety of other disciplines. Particular emphasis was placed on propositional learning cards in a multiple true-false format. A one group pre-test-post-test pilot study concerning connective tissue histology revealed a highly significant knowledge gain based on propositional MicroLearning. Rollout of the MicroLearning system to the students is scheduled for winter term 2017/18.

Key words E-learning – MicroLearning – Medical training – University Education – Health Professional Education

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Definition of MicroLearning The concept of MicroLearning has been developed by Research Studios Austria FG during the last two decades(1). MicroLearning is a special type of technology enhanced learning which is designed to support short learning sequences and particularly fit to the use of mobile, handheld devices such as tablets and smartphones. MicroLearning capitalizes on the present day ubiquitous availability of mobile phones, be it over telecom networks or wireless LANs. MicroLearning is considered particularly relevant to Technology Enhanced Learning in Health Professions Education for its properties facilitate, support, enhance and extend the reach of teaching and learning activities(1). In MicroLearning, contents are split into small chunks(many time also called nuggets), with each chunk defined to fit well on the screen of a smartphone. Each chunk is termed a learning card, and learning cards may be hierarchically arranged according to topics and disciplines. Typically, each learning card requires user interaction, most often as a multiple choice activity. A MicroLearning session may last a few seconds according to users choice and should not last more than up to 5 minutes according to learning design(2). Because of the mobility of the devices and the short duration of learning sessions, MicroLearning is well suited to and prone to take place anywhere, anytime.

Principles of MicroLearning The learning card as the basic element of MicroLearning systems facilitates the application of several principles which are salient features of successful learning environments. At first, learning cards can be repeated for several times, making use of Thorndike’s power law of practice(3). Electronic systems are often programmed to provide repetitions in increasing intervals, exploiting the so-called spacing effect(4), as originally described by Ebbinghaus(5). Furthermore, user interaction requiring the solution of multiple choice problems or self-assessment questions make use of the testing effect(6). The testing effect refers to the fact that retrieval of information has a more pronounced influence on long term retention than simply studying the same information. In addition, mixed media including sound, images and video can be incorporated in or linked to learning cards, further enhancing learning and understanding according to the multimedia effect(7). Finally, MicroLearning systems may offer gaming and competition(8), which might have an additional positive effect on learners’ motivation and personal engagement.

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The KnowledgeFox® software In the current project, the Medical University of Graz (Med Uni Graz) has started collaboration with the KnowledgeFox Company, providing the MicroLearning software KnowledgeFox®. This is a readyto-use MicroLearning system which is already commercially available. KnowledgeFox® incorporates all of the MicroLearning principles described above. The software provides currently four types of learning cards: (i) multiple-choice-single-select cards, where the user has to make a single choice between two to five options; (ii) multiple-choice-multipleselect cards, with one to five options where any proportion of these may be true or false; (iii) selfassessment cards requiring the user to actively create a covert response and to compare it with the correct solution; finally (iv) information cards without user interaction. In addition to a question and the corresponding options, each learning card can be enriched by providing a broader context to the question and a more thorough explanation yielding elaborated feedback. Thus a learning card becomes a real “knowledge card” with a learning effectiveness beyond that of pure multiple choice formats. The knowledge cards in the KnowledgeFox® system are hierarchically grouped into lessons, courses and categories, with about 10 to 40 knowledge cards per lesson, 2 to 15 lessons per course, and one to a large number of courses per category. Besides expanding learning into knowledge cards, the KnowledgeFox® system provides additional features for user interaction. The learners are enabled and encouraged to provide feedback on content to authors using both a predefined response format as well as an open text format with up to 160 characters of feedback. Furthermore, learners have the possibility to create knowledge cards on their own – both in text and pictures - and can decide whether their user-generated cards should remain “personal” to them as users who have authored them or whether these cards should be offered to other learners. This system hands the decision about publication to the course responsible or author. Concerning learning analytics, KnowledgeFox® includes a statistical overview on learner and author activities as well as detailed log data as an indispensable prerequisite for educational research.

The MicroLearning project of the Medical University of Graz The e-learning activities of the Med Uni Graz started in 2002 with the implementation of the Virtual Medical Campus (VMC) Graz(9). In the first years, a custom-made e-learning system was used. Since 2010, the VMC is based on the open source software MOODLE. At present, the VMC comprises about 10.000 learning objects and shows about 90.000 hits per week during study term.

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Smolle / Bruck | MicroLearning in Undergraduate Medical Education | October 2017 In 2016, the project “MicroLearning Medical Propedeutics: Harmonization, Compatibility and Community Outreach” received financing form the Federal Ministry of Science, Research and Economy. As a cornerstone of this project, the KnowledgeFox® software was licensed to provide an extension of the VMC towards mobile learning / MicroLearning. In the meantime, the first author has created more than 8000 knowledge cards, arranged in 334 lessens and in 102 courses. To date, the contents comprise histology and embryology; pharmacology; basics of thoracic surgery; and clinical skills. In addition, several pilot lessons have been created for various disciplines. Rollout for the students takes place in winter term 2017/18, with written and oral information to the students about MicroLearning.

Propositional MicroLearning In the generation of knowledge cards, particular emphasis was placed on propositional MicroLearning. A proposition is the smallest unit of information which can stand on its own and which can be judged as either true or false(10). As a rapid content development procedure, conventional lecture notes and presentations were transformed into MicroLearning content by starting with a list of true propositions covering the essential information of the lecture. As a next step, for each true proposition a contrasting false proposition was created, and short explanations were written for each of the true and false propositions. Using a newly developed algorithm written in Visual Basic for Applications (Microsoft, Redmond, USA), true and false propositions were randomly combined, resulting in multiple-choice-multiple-select learning cards of the multiple true-false type. This propositional approach to the generation of MicroLearning content has the advantage that one need not transform any information into a question, but can instead formulate a straight-forward proposition. Additionally, converting the true propositions into “meaningful” false propositions provides suitable distractors. Together with the appropriate explanations, real knowledge cards with elaborate feedback are created by a semi-automatic process.

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A pilot study on knowledge gain using propositional MicroLearning We can briefly report on a one group pre-test-post-test pilot action research study on potential knowledge gain with propositional MicroLearning cards. The topic was selected from the histology lessons and referred to histology of connective tissue. Preand post-test were of conventional multiple choice-single select format, while the MicroLearning lessons contained exclusively propositional multiple-true-false learning cards. 40 students completed the study. Propositional MicroLearning enhanced the test results significantly from 17,4+-0,7 out of 36 items in the pre-test to 28,6+-1,2 items in the post-test (t-test for paired samples: p < 0.001). The increase in test performance did not depend on either prior knowledge or gender. These findings are encouraging to evaluate the propositional MicroLearning approach in some more detail. We expect to be able to report more research as the project progresses. We are particularly interested in exploring how MicroLearning can be used in other fields and contexts in health professions education, particularly when it comes to continued, certification oriented education. We have shown in other research that work place health support interventions can significantly impact an aging work force with mobile MicroLearning. Evaluation in a multiple-case study at three work sites with 86 users show that mobile MicroLearning (health quiz) contributed to improvements in health readiness,−behaviour and -competence. Participants indicated that health insights were given that directly influenced every day health perceptions, −choices, coping and goal achievement strategies, plus motivation and self-norms. Thus we could report increased user health self-management competence and even after 10 months users indicated to still have improved health awareness, −motivation and -behaviours (food, physical activity, mental recuperation) (11).

Acknowledgement This study was supported in part by a grant of the Austrian Federal Ministry of Science, Research and Economy - HRSM project “MicroLearning Medizinische Propädeutik: Harmonisierung, Vereinbarkeit und Community Outreach”

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