Usage and perceptions of anatomy case-based learning

Usage and perceptions of anatomy case-based learning; comparison of small group teaching and online eLearning resources Jane Holland MD PhD PgDipEd 1Senior

Student survey responses; usage and perceptions (quantitative) • Of the students who responded to the survey questions (n = 132) regarding enjoyment, usefulness, feedback and case complexity, the majority of students responded favorably to both the cases used for discussion within the anatomy room, and the new online lessons (Table 1) • While more students acknowledged completing the case in the anatomy room as compared to online, students rated the online case more favourably than the anatomy room case with regard to (1) enjoyment (2) usefulness and (3) feedback • Reassuringly, most students indicated that they were satisfied with the level of complexity of the cases Q26. How enjoyable did you find the experience of completing these Casestudies?

Q27. How useful are these CaseStudies in promoting your learning and understanding of anatomical concepts?

Q28. How useful did you find the feedback you received when completing these Case studies?

Q29. How would you rate the clinical complexity of the casestudies in relation to your level of knowledge?

122

122

104

121

3 (122)

4 (122)

3 (104)

3 (121)

N - online

88.69 67

92.16 73

81.16 69

96.5 69

Median - online

4 (67)

4 (73)

4 (69)

3

106.49 4,856.5 .025

107.75 5,165 .05

95.8 4,195.5 .048

93.74 4,053 .604

Table 1 N - anatomy Median - anatomy

Methods • Case-based eLearning activities, derived from existing cases discussed within our GIHEP (Gastrointestinal-hepatology) anatomy small group tutorials, were created incorporating instructional design principles such as interactivity, reinforcement and feedback 3, 4, • Simple patient scenario, incorporating a small number of positive clinical signs & symptoms This is followed by a number of questions pages exploring simple anatomical and clinical aspects • Specific, integrated feedback can be given for each choice or answer given, whether correct or incorrect • A final page then summarises the lesson content • Following ethical approval (REC001085) , we then examined students’ usage of these activities, and their preferences and perceptions regarding both of these aligned case-based activities with regard to aspects such as enjoyment, usefulness and feedback Data collection • Data were collected from two separate sources: (1) usage of the online case-studies from online logs; (2) anonymous survey responses

Students’ usage; online activity data • The number of students accessing each of the eight online case-based lessons at 5 key time points were considered; (a) the day of dissection, (b) 1 week after dissection, (c) 28 days after dissection, (d) 1 week before the GIHEP examination and (e) the day of the GIHEP examination. • Over half of the students in the class accessed one or more of these online lessons • Only 18% of students (n = 56) accessed all eight cases • While many students accessed these lessons either before or immediately after the associated cadaveric small group tutorials (SGT), use of these lessons increased substantially later in the semester, in the period of time just prior to the examinations (Figure 1) • Students typically accessed these cases on weekdays (maximally Wednesday; χ2(6, n = 812) = 82.43, p < .0005) Figure 1. Students’ usage; online activity data

& Teresa Pawlikowska MB BS MRCP

2 PhD

Lecturer in Anatomy, 2 Director Health Professions Education Centre

Background • Case-based learning can play a valuable role in enabling undergraduate medical students to apply their knowledge to contextual clinical situations, and the subsequent development of critical thinking skills 1 • The scheduling of dedicated small group tutorials to facilitate these case-based discussions can be challenging, and many institutions, are looking to develop online, interactive lessons and bespoke virtual patients • However, prior research examining the use of eLearning resources show variable outcomes and benefits, often dependent on how these resources are introduced and integrated with existing activities and learning objectives 2,3

1 MRCSI

Mean rank

Mean rank MW U P (2-sided)

Student survey responses; free text comments (qualitative) Twenty-nine students submitted a total of 48 free-text comments, which were generally positive for both case formats. However, two students either did not feel did not feel that they were useful, or else overlooked them entirely.

Requests for additional cases Students communicated that more of these cases should be emphasised more in tutorials, or made available online: • “Case studies should be discussed more during anatomy practicals” • “Wish to have more online case studies, it is really useful” • “Very helpful, must be applied to other moudles [sic] with anatomy lectures”

Discussion with staff in small group tutorials Many students indicated a preference for discussion in anatomy SGTs as opposed to alone online, in contrast to the quantitative data (Table 1): • “It was better when discussed with lecturers and colleagues.” • “The cases studies are more understandable when discussed in the anatomy room with prosectors rather than do it on our own” • “These case studies would be a more valuable aid if they were done as an activity in class or small group tutorials” One student confided that they were more likely to complete these cases if encouraged to do so with staff, as opposed to independently: • “the case studies are better if they are implemented within the lecture there would be more chance that we are gonna have look at it as if it was on the online only course”

Promoting deeper knowledge and understanding Most comments indicated that students found these resources useful in promoting deeper knowledge and understanding of the course material: • “Concise summaries of content, very useful for developing core info.” • “Cases were very useful. The summary provided by the end of the case [online format] is well organized and understandable. If possible to recommend books for cases”

Conclusions Our data confirm that both case-based resources are a useful adjunct to anatomy teaching in either small group discussions, or as online eLearning resources. While students appeared to rate the eLearning resource higher than the small group case discussions, more students participated in SGT discussions that completed the online versions of the cases. In addition, our data suggest that those students who do complete these cases online tend to do so towards the end of the semester as a revision aide, instead of concurrently, when learning the corresponding content via lectures or anatomy room tutorials. Providing these as optional online activities does mean that some students will omit them from their study, and so consideration should be made from the outset as to whether the information contained within should be core, or complementary, to the existing curriculum.

References 1. Thistlethwaite JE, Davies D, Ekeocha S, et al. The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23. Med Teach. 2012;34:e421-e444. 2. Hege I, Ropp V, Adler M, et al. Experiences with different integration strategies of case-based e-learning. Med Teach. 2007;29:791-797. 3. Cook DA. Web-based learning: pros, cons and controversies. Clinical Medicine. 2007;7:37-42 4. Chowdhury & Kalu. 2004. Learning to give feedback in medical education. The Obstetrician & Gynaecologist, 6, 243-247.

Usage and perceptions of anatomy case-based learning; comparison of small group teaching and online eLearning resources Jane Holland MD PhD PgDipEd 1Senior

1 MRCSI

& Teresa Pawlikowska MB BS MRCP

2 PhD

Lecturer in Anatomy, 2 Director Health Professions Education Centre

Background While case-based learning can empower students to apply their knowledge to contextual clinical situations, developing critical thinking skills, scheduling of activities to facilitate this is a challenge. Developing clinical cases as eLearning activities is an alternative, but requires appropriate instructional design and implementation, in order to ensure effectiveness and student engagement. Summary of work Case-based eLearning activities, derived from existing cases discussed within our anatomy small group tutorials, were created incorporating instructional design principles such as interactivity, reinforcement and feedback. Following ethical approval, we then examined students’ usage, preferences and perceptions regarding both formats, with regard to aspects such as enjoyment, usefulness and feedback. Data were collected from two separate sources: (1) usage of the online case-studies from online logs; (2) anonymous survey responses. Summary of results While students enjoyed completing cases in both formats, the online lesson was rated significantly higher than the anatomy room discussions with regards to enjoyment (4 vs 3; p= .025), usefulness (4 vs 4; U= 5.165, p= .05) and feedback (4 vs 3; p= .048). However, more students discussed these cases in small groups than completed them online, and free-text survey comments indicated a preference for group discussions. In addition, students who did complete the online cases tended to do so towards the end of the semester as a revision aide, instead of concurrently, when learning the corresponding content via lectures or anatomy room tutorials. Discussion and conclusions While students rated both versions of these case-based learning resources favourably, quantitative Likerts showed a significant preference for online cases as compared to group discussions, with regards to enjoyment, usefulness and feedback. However, more students discussed cases in tutorials than completed the online versions, which they seemed to use as more of a revision aide.

Take-home messages Case-based learning is a useful in either small group discussions, or as eLearning activities. However, introducing cases as optional activities does mean that students may omit or overlook them, and so consideration should be made from the outset as to whether the information contained within should be core, or complementary, to the existing curriculum. Conflict of interests statement No conflict of interests to declare Citation: Holland JC, Pawlikowska T. Usage and perceptions of anatomy case-based learning; comparison of small group teaching and online eLearning resources. Poster presented at AMEE, 27 – 29 August 2018, Basel, Switzerland Full-text article: Holland JC, Pawlikowska T. Undergraduate medical students’ usage and perceptions of anatomical case-based learning: Comparison of facilitated small group discussions and eLearning resources. In Press, Anatomical Sciences Education