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A comparison of teaching three common ear, nose,

and throat conditions to medical students through
Advances in Medical Education and Practice downloaded from https://www.dovepress.com/ by 95.181.182.82 on 24-Dec-2018

video podcasts and written handouts:  a pilot study

This article was published in the following Dove Press journal:
Advances in Medical Education and Practice
10 May 2016
Number of times this article has been viewed

Mark Edmond 1 Background: This pilot study conducted at the Peninsula Medical School is one of very few
Francesca Neville 2 studies to compare the use of video podcasts to traditional learning resources for medical students.
Hisham S Khalil 3 Methods: We developed written handouts and video podcasts for three common ear, nose, and
throat conditions; epistaxis, otitis media, and tonsillitis. Forty-one second-year students were
1
Peninsula Medical School, Plymouth,
For personal use only.

United Kingdom; 2ENT Department, recruited via email. Students completed a 60-item true or false statement test written by the senior
Plymouth Hospitals NHS Trust, author (20 questions per subject). Students were subsequently randomized to podcast or handouts.
Plymouth, United Kingdom; 3Plymouth
Students were able to access their resource via their unique university login on the university
University Peninsula School of
Medicine, Plymouth, United Kingdom homepage and were given 3 weeks to use their resource. They then completed the same 60-item test.
Results: Both podcasts and handouts demonstrated a statistically significant increase in stu-
dent scores (podcasts mean increase in scores 4.7, P=0.004, 95% confidence interval =0.07).
Handout mean increase in scores 5.3, P=0.015, 95% confidence interval =0.11). However,
there was no significant difference (P=0.07) between the two, with the handout group scoring
fractionally higher ­(podcasts average post-exposure score =37.3 vs handout 37.8) with a larger
Video abstract average improvement. A 5-point Likert scale questionnaire demonstrated that medical students
enjoy using reusable learning objects such as podcasts and feel that they should be used more
in their curriculum.
Conclusion: Podcasts are as good as traditional handouts in teaching second-year medical
students three core ear, nose, and throat conditions and enhance their learning experience.
Keywords: e-learning, epistaxis, otitis media, tonsillitis, RCT

Background
Ear, nose, and throat (ENT) surgery must compete with many other subjects for space
in undergraduate medical education. As highlighted by Mace and Narula in their review
Point your SmartPhone at the code above. If you have a
of ENT education in 26 universities in the United Kingdom, ENT only receives an aver-
QR code reader the video abstract will appear. Or use: age of 1.5 weeks in the medical school curriculum and is often taught as a combined
http://youtu.be/Oc65J3OlEHg
subject with other specialties.1 Consequently, it is imperative for ENT education to be
delivered in an efficient manner and utilize the best methods of delivery available. Medi-
cal education is undergoing vast changes. Education no longer follows the traditional
model of instructor-centered education, it is now more centered around independent
learning, with the emphasis on the learner constructing their own knowledge.2
Reusable learning objects (RLOs) are a new method of delivering medical educa-
Correspondence: Hisham S Khalil
Peninsula Schools of Medicine and tion that incorporate a spectrum of visual, auditory, and interactive learning resources.
Dentistry, Level 2, John Bull Building, A learning object can be defined as a grouping of instructional materials to meet a
Tamar Science Park, Derriford, Plymouth,
PL6 8BU, United Kingdom
specified educational objective. A digital learning object is one which can be electroni-
Email hisham.khalil@plymouth.ac.uk cally stored and may utilize text, graphic, animations, audio, and video to support and

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http://dx.doi.org/10.2147/AMEP.S101099
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 Edmond et al Dovepress

enhance learning. Due to their electronic nature, they can be 2-week period to complete the test in an attempt to reduce
considered to be reusable since they can be accessed by many the dropout rate.
users if hosted online.3 RLOs are a resource that are designed
to be used in self-directed learning (SDL) and are therefore Exposure to resources
an ideal tool to help students in modern medical education. Upon completion of the initial exam, the participants were
Video podcasts have the added advantage of engaging given access to their allocated learning resource for a 3-week
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students in both auditory and spatial learning compared to period. Each resource was hosted on the Peninsula Medical
other SDL tools such as handouts, that allow spatial learning School’s virtual learning environment (EMILY). The relevant
only. There have only been very few studies that have directly resource was made visible on the homepage of the student
compared the effect of podcasts with other SDL tools in terms by using their individual login ID. Therefore, nobody apart
of learning topics in medicine.4–6 This pilot study compares from the investigators was able to see both resources. Stu-
the use of podcasts with more traditional handouts in self- dents in the handout group were able to save or print their
directed education across three common ENT conditions handouts. Students were requested not to share each other’s
namely epistaxis, otitis media, and tonsillitis. resources or use any supporting material including the printed
­handouts when completing the post-exposure test. There were
Methods no additional instructions, so the students were able to use
Ethics approval and recruitment their allocated resource as they saw fit.
The Peninsula College of Medicine and Dentistry Ethics
For personal use only.

Committee approved the study. All second-year medical Post-exposure test

students at Peninsula Medical School within the Plymouth After the completion of the 3-week period, the resources
locality (103 students) were notified of the study via uni- were removed from EMILY and the students were sent an
versity email account. Attached to the email were the study email with a link to the same 60-item Survey Monkey™ test
protocol, a frequently asked questions sheet, and a consent they sat previously. Again, students were given 2 weeks to
form. Second-year students were chosen as the target popula- complete this under the same conditions as before.
tion since they have received no formal ENT teaching in their
prior curriculum. The students were initially given 1 week to Student questionnaire
respond to the email. This was extended to 2 weeks with an Qualitative data regarding level of enjoyment of the learning
email reminder at the end of the first week in order to increase resource were also collected from the podcast group in the
the chances of gaining a statistically significant sample size. form of a 5-point Likert scale questionnaire.

Randomization Statistical analysis

Students were randomized to the podcasts group or the hand- Comparisons were made on the students’ performance scores
out group using a computerized random number generator. before and after the interventions. The mean and standard
deviations of the pre- and post-exposure test results of stu-
Pre-exposure test dents in both groups were computed and the normality of data
Following randomization, the participants were sent a unique tested using the Shapiro–Wilk test. Mean difference between
link to a Survey Monkey™ 20 true or false statements for pre- and post-exposure scores were calculated for each
each of the three topics (epistaxis, tonsillitis, and otitis group. The Shapiro–Wilk test showed the data to be normally
media). The questions were written by the senior author, an distributed. These data were then analyzed for a significant
ENT consultant from Plymouth Hospitals NHS Trust. An difference using a Student’s paired t-test. The null hypothesis
online and remote method was chosen to conduct the entire was that there was no improvement between pre- and post-test
study because a previous attempt to invite the students to sit scores in the podcast group when compared with the handout
an exam under exam conditions onsite at the Medical School group. The difference was considered statistically significant
had only yielded eight responses. The students were asked if P=<0.05. The breakdown of the data by subject allowed
to not use any resources while sitting the test and that it us to see whether podcasts were effective across a range of
should take no longer than 10 minutes. The test would “lock” different subjects, or more effective in some and not others.
after one login attempt. Therefore, the test would need to be The data of the Likert questionnaire were analyzed by
completed in one sitting. The 41 respondents were given a calculating the mode response for each question.

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 Dovepress Use of podcasts for medical students

Results and written handouts. Figure 4 illustrates the average post-

Figure 1 is a flowchart of the study. Forty-one out of 103 exposure test scores for the podcast and written handouts
students responded to the email inviting them to participate groups. The average improvement from the podcast group
in the study (39.8%). Thirty out of the 41 students who agreed was 4.7 (P=0.004, 95% confidence interval =0.07) compared
to participate in the study completed the pre-exposure test to 5.3 from the handouts group (P=0.015, 95% confidence
(73.2%). Eighteen students out of 41 who agreed to partici- interval =0.11). There was however no statistically significant
Advances in Medical Education and Practice downloaded from https://www.dovepress.com/ by 95.181.182.82 on 24-Dec-2018

pate in the study completed the post-exposure test (43.9%). difference found between the use of podcasts and written
Figures 2 and 3 are box plots of test scores pre- and handouts in improving students’ knowledge scores (average
post-exposure. There was a statistically significant improve- post-exposure scores 37.8 vs 38.3, P=0.07). Figures 5 and
ment in knowledge scores after provision of both podcasts 6 illustrate the findings of the Likert scale questionnaire

Responded to email
Q 

9 did not attempt test, 2 did

not complete fully
For personal use only.

Fully completed
pre-exposure test
Q 

Randomized to podcast Randomized to handout

group group
Q  Q 

6 from podcast and 6 from

the handout group did not
complete test within allotted
Fully completed time period
post-exposure test
Q 

Fully completed satisfaction

questionnaires from
podcast group
Q 

Figure 1 Population flowchart.

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 Edmond et al Dovepress

 been summarized in Table 1 which is adapted from a literature

review.7 Our findings are supported by the limited literature
6FRUHPD[


available on the use of podcasts for medical students.
 Cook published a review on the use of web-based
learning (WBL) in medical education. He concluded that

the advantages of WBL include overcoming barriers of
Advances in Medical Education and Practice downloaded from https://www.dovepress.com/ by 95.181.182.82 on 24-Dec-2018

 distance and time, economies of scale, and novel instruc-

tional methods. The disadvantages include social isolation,
Figure 2 Box plot of average pre-exposure test scores. up-front costs, and technical problems. WBL instructional
designs failed to always abide by educational principles and
 may sometimes be used in an incorrect educational context
 or application.8
 Bhatti et al evaluated the benefit of educating medical
students on a common surgical topic (hemorrhoids), through
6FRUHPD[


a website and podcast package vs a traditional lecture. Similar

to our study, the authors used a pre-intervention question-

naire and an identical post-intervention one. They concluded

that using augmented web-based educational tools reduces

For personal use only.

demands on teaching time with no decrease in quality for


3RGFDVW +DQGRXW selected parts of the curriculum.4
Kumar et al implemented a hybrid curriculum that
Figure 3 Box plot of average post-exposure test scores.
involved both traditional teaching methods and a new online
core curriculum that incorporates audio, video, and text using


screen capture technology in a surgical intensive care unit
 
$YHUDJHVFRUHPD[

clinical placement. The curriculum was hosted on a secure


 online portal and covered topics that were considered essen-
 tial to meet the didactic objectives of the rotation. Students


in both groups completed a pre-test on day 1 of the rotation
 and a post-test administered on the second to last day of the

rotation. Unlike our study, the authors did not use identical

 questionnaires but randomly selected ones before and after
3RGFDVW +DQGRXW the intervention. Again, the authors found that using this
Figure 4 Average post-exposure test scores. form of learning enhanced the satisfaction of students on
a busy intensive care unit placement and improved their
knowledge-based test scores.6
responses of students in the p­ odcast group. The podcast ques- A study by Peacock et al came to a different conclusion
tionnaire showed in addition, that students valued this as a from our study. They conducted a prospective observational
learning resource and found it to be a more enjoyable method study of all medical students undertaking their first attach-
of learning. The dropout rates post-exposure was identical ment in surgery. Students were randomly allocated to four
in both groups (n=6). Only 40% (n=6) of the podcast group groups: lecture, handout, website, and patient-based tuto-
returned their satisfaction questionnaires. rial, all on the management of an inguinal hernia. Although
the knowledge scores improved in the lecture and website
Discussion groups, the learning in the website group was thought to be
Our study demonstrates that video podcasts are as effective less engaging for students.5
as written handouts in teaching three common ENT condi- With the evolution of technology and its ever growing
tions. However, the students’ learning experience in the degree of accessibility, the potential role of video podcasts
podcast group appeared to be enhanced compared to written in medical education should be recognized and utilized. This
information they traditionally use as the podcasts were more can be especially useful in modern medical degree programs
enjoyable. The advantages and disadvantages of RLO’s have which favor a problem-based learning approach. These

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 Dovepress Use of podcasts for medical students

/LNHUW ³9LGHRSRGFDVWLQJVKRXOGEHXVHGLQ p­ rograms often have limited face-to-face teaching time and
VFDOH PHGLFDOHGXFDWLRQLQWKHIXWXUH´
rely on individual independent learning. The use of podcasts

here could help standardize the information which students
 
 are given on a particular topic and can be accessed in their
 own time and at their own pace.
The potential implications for teachers involved in
Advances in Medical Education and Practice downloaded from https://www.dovepress.com/ by 95.181.182.82 on 24-Dec-2018


   medical education are highlighted in Table 1. However, the

6WURQJO\ 'LVDJUHH 1HLWKHU $JUHH 6WURQJO\ usefulness and enjoyment of podcasts from the perspective
GLVDJUHH GLVDJUHH DJUHH of the clinical teacher goes beyond the scope of this study.
QRUDJUHH
The main limitation of this pilot relates to the number of
Figure 5 Students’ opinions on use of video podcasts. participating students as a type II error cannot be excluded.
The results of this study can assist us in calculating the sample
size required to perform a larger scale study. The dropout
rate for students completing voluntary assessments is not
³&RPSDUHGZLWKSDSHUKDQGRXWVRQ unusual. Similarly, it is not unusual to have low response
WKHVDPHVXEMHFWYLGHRSRGFDVWVDUH rates for study questionnaires. The students did not sit the
PRUHXVHIXO´
 test under exam conditions and were able to sit both the pre-

 and post-exposure test at any point in a 2-week period. The

For personal use only.

 investigators were aware of this limitation at the start of the


   investigation; however, it was deemed necessary in order to
 gain a much larger sample size than was previously obtained.
6WURQJO\ 'LVDJUHH 1HLWKHU $JUHH 6WURQJO\DJUHH
GLVDJUHH GLVDJUHH Although students were requested not to share resources,
QRUDJUHH
there is no way to find out if this has occurred. Providing the
Figure 6 Students’ opinions on usefulness of video podcasts compared to written students with the same pre- and post-test assessment could
material.
have led to a “repeat testing bias”. This risk is mitigated by
the fact that students did not have prior experience of ENT
when they sat the first test. Moreover, test equating has its
challenges and using a different test post-exposure carries
the risk of using an assessment that does not have the same
Table 1 Advantages and disadvantages of digital learning objects degree of difficulty as the pre-test.
Advantages for students Disadvantages for students Given that there are very few studies that have looked
• Available at any time and any • Unfamiliarity with RLOs at the effectiveness of video podcasts as teaching tools for
location as long as they have • Resistance to change medical students,4–6 we therefore propose a definitive follow-
computer or mobile device access
• Individuality
up study that includes more than one medical discipline.
• Provides for a variety of learning This study has shown that RLOs such as video podcasts are
styles and preferences as good a resource as handouts in terms of knowledge test
Advantages for teachers Disadvantages for teachers scores, but also that they are more enjoyable.
• They are reusable • Lack of experience
• Consistent designs and • Requires technological Conclusion
development process support and necessary hosting
Video podcasts are as good as written handouts in the teaching
• Existing content can be used to resources
construct the learning objectives and learning of three common ENT conditions. Video podcasts
• Learners’ use of materials can be appear to enhance the students’ learning experience. Further
monitored large-scale studies are required to demonstrate the effectiveness
• Affordable
• Standardizes content for
of podcasts in medical education compared to other widely
widespread use used learning resources and involving multiple disciplines.
• Accommodates a wide range of
teaching preferences
Note: Data from Sandars J, Schroter S.7
Disclosure
Abbreviation: RLOs, reusable learning objects. The authors report no conflicts of interest in this work.

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5. Peacock O, Watts E, Foreman D, Lund JN, Tierney GM. Evaluation of

References teaching methods for students on hernias: an observational study. ANZ
1. Mace AD, Narula AA. Survey of current undergraduate otolaryn- J Surg. 2013;83(1-2):11–14.
gology training in the United Kingdom. J Laryngol Olol. 2004; 6. Kumar AB, Hata JS, Bayman EO, Krishnan S. Implementing a hybrid
118(3):217–220. web-based curriculum for an elective medical student clerkship in a
2. Bannan-Ritland B. The role of design in research: the integrative learn- busy surgical intensive care unit (ICU): effect on test and satisfaction
ing design framework. Educational Researcher. 2003;32(1):21–24. scores. J Surg Educ. 2013;70(1):109–116.
3. Ruiz JG, Mintzer MJ, Leipzig RM. The impact of E-learning in medical 7. Sandars J, Schroter S. Web 2.0 technologies for undergraduate and
Advances in Medical Education and Practice downloaded from https://www.dovepress.com/ by 95.181.182.82 on 24-Dec-2018

education. Acad Med. 2006;81(3):207–212. postgraduate medical education: an online survey. Postgrad Med J.
4. Bhatti I, Jones K, Richardson L, Foreman D, Lund J, Tierney G. 2007;83(9856):759–762.
E-learning vs lecture: which is the best approach to surgical teaching? 8. Cook DA. Web-based learning: pros, cons and controversies. Clin Med
Colorectal Dis. 2011;13(4):459–462. (Lond). 2007;7(1):37–42.
For personal use only.

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