How Can Medical Students Be Prepared Effectively for Current Challenges in the Field of Expert-Guided Online-Counselling on Preventive Interventions? - A Randomised, Prospective Trial Exemplified by a Case Study of Mammography-Screening

Abstract

Introduction The impact of the Internet on medical care leads to various medical information sources for patients and to an increasing demand for online-counselling. Thus new challenges for doctors arise. Aim of this project is to close the gap between these challenges and the current lack in options to prepare medical students for them. A training program in a blended-learning format with an online-platform as training instrument was designed and implemented into a gynaecology course during 9th semester of medical curriculum. It was analysed on basis of the following research question: How can medical students be prepared effectively for current challenges in the field of expert-guided online-counselling on preventive interventions? - A randomised, prospective trial exemplified by a case study of Mammography-Screening 1. How does an online-forum need to be designed, in order to provide an adequate training instrument simulating the arising challenges with a high level in closeness to reality? 2. Which didactical blended-learning approach (trainer-directed or self-directed) is most appropriate to prepare students effectively?

Methods The online-forum’s development is shown as well as the establishment of the two course formats along Kern’s model. In a prospective, randomised, parallel group study the training outcome is evaluated by standardised and blinded pre/post analysis using a test, in which students counselled a simulated patient request through the forum. This was followed by an online-survey for students’ self-assessment regarding the learning objectives. The survey also collected data on students’ characteristics and course evaluation.

Results The data shows a G*Power (1-β) > .8 and no significant differences between sociodemographic aspects (p > .05) of the two groups (G1, G2). Students’ evaluation (lowest: 1, best: 5) results as follows: external organisational circumstances (time, distances) (mean = 2.79; SD = .142), performance and moderation of the course (mean = 4.19; SD = .104), application of online-forum (mean = 3.90; SD = .103). The students of the self-directed group (G1) show a significant increase in their self-assessment (doctor-patient communication: Z = -2.036; p =.042; online-communication: Z = -2.058; p =.04), implemented independent online-research (p =.073) during independent training more often than G2 students and completed more training cases in any range.

Discussion The data indicates great suitability of the online-forum for training and its high acceptance amongst the students. However, external organisational circumstances were criticised. The forum supports the effectiveness of training and since it is an instructional method in fields of simulation-based learning, it is shown to raise the effectiveness of medical education. Students of G1 (self-directed) arise to show a better learning outcome and their higher activity level correlates with their significantly raised self-assessment regarding the topical learning objectives. This is supported by scientific evidence describing the strengths of blended-learning and self-directed learning approaches in medical education. In particular, the limitation of self-assessment as a method for characterising the students’ learning outcome needs to be regarded, since it is shown to be highly vulnerable to rater biases. Thus aligning the results with the subsequent OSCE evaluation of the students’ texts from the pre/post test in the forum arises as relevant. In addition, the forum’s content and features’ high level in flexibility allows easy transfer to further disciplines and target groups.

Conclusion The blended-learning course with the online-forum as training instrument provides a basis for an effective training of medical students in fields of expert-guided online-counselling regarding preventive interventions. Its transfer to other target groups in a self-directed approach arises as major perspective. The alignment of data from self-assessment with the subsequent OSCE evaluation arises as further relevant perspective, since its preliminary results appear to highly significantly confirm the tendency described throughout this study.