Subscribe to RSS

DOI: 10.1055/a-2389-9410
Insights Into Modern Undergraduate Ultrasound Education: Prospective Comparison of Digital and Analog Teaching Resources in a Flipped Classroom Concept – The DIvAN Study

Abstract
Purpose Sonography training has become an important part of university medicine courses. This study explores the impact of digital and analog teaching resources on learning outcomes, knowledge retention, and student preferences and motivation in a flipped classroom setting.
Materials and Methods This prospective controlled study involving two groups of third-year medical students included a voluntary three-day compact ultrasound course given in a flipped classroom, comprising 26 teaching units of 45 minutes each. Hardcopy lecture notes (control group) and E-learning (study group) were used as teaching resources. Evaluations were conducted before (pre) and during the preparation phase (intermediate), and after (post) the face-to-face course. Likert scale responses, written theory tests with very short answer questions (Theorypre, Theoryinter, Theorypost), and practical examinations (Practiceinter, Practicepost) were used for student self-assessment and to measure attitude, motivation, as well as theoretical and practical skills.
Results A total of N=236 complete data sets (study group n=136; control group n=100) were analyzed. Both groups showed an equivalent initial level of, and a continuous and significant (p<0.01) increase in, subjective and objective skills over the evaluated time frame. The study group achieved significantly (p<0.05) better results in Theoryinter, Theorypost, Practiceinter, and Practicepost. The study group evaluated their teaching resource and the training concept significantly (p<0.05) better.
Conclusion The integration of digital resources into sonography education provides comparable learning outcomes to traditional analog materials, enhancing the preparatory phase. In the future, digitally supported training should be used more.
Keywords
ultrasound education - blended learning - flipped classroom - E-Learning - ultrasound training‡ These authors contributed equally to this work and share first authorship
# These authors contributed equally to this work and share senior authorship
Publication History
Received: 05 April 2024
Accepted after revision: 25 July 2024
Article published online:
09 October 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
Johannes M. Weimer, Florian Recker, Leonie Horn, Julian Kuenzel, Klaus Dirks, Carlotta Ille, Holger Buggenhagen, Norbert Börner, Andreas Michael Weimer, Thomas Vieth, Liv Lorenz, Maximilian Rink, Daniel Merkel, Anna Dionysopoulou, Michael Ludwig, Roman Kloeckner, Julia Weinmann-Menke, Lukas Müller. Insights Into Modern Undergraduate Ultrasound Education: Prospective Comparison of Digital and Analog Teaching Resources in a Flipped Classroom Concept – The DIvAN Study. Ultrasound Int Open 2024; 10: a23899410.
DOI: 10.1055/a-2389-9410
-
References
- 1
Dietrich CF,
Bolondi L,
Duck F,
Evans DH,
Ewertsen C,
Fraser AG.
et al.
History of Ultrasound in Medicine from its birth to date (2022), on occasion of the
50 Years Anniversary of EFSUMB. A publication of the European Federation of Societies
for Ultrasound In Medicine and Biology (EFSUMB), designed to record the historical
development of medical ultrasound. Med Ultrason 2022; 24: 434-450
MissingFormLabel
- 2
Höpfner M,
Weskott HP.
Fusion imaging – ein neues Verfahren zur Bildfusion sonografischer und radiologischer
Schnittbildverfahren. Ultraschall Med. 2009 30. V18_02.
MissingFormLabel
- 3
Clevert DA,
Beyer G,
Nieß H,
Schlenker B.
Ultrasound—New Techniques Are Extending the Applications. Dtsch Arztebl Int 2023;
120: 41-47
MissingFormLabel
- 4
Weimer JM,
Beer D,
Schneider C,
Yousefzada M,
Gottwald M,
Züllich TF.
et al.
Inter-System Variability of Eight Different Handheld Ultrasound (HHUS) Devices—
A Prospective Comparison of B-Scan Quality and Clinical Significance in Intensive
Care. Diagnostics 2024; 14: 54
MissingFormLabel
- 5
Merkel D,
Züllich TF,
Schneider C,
Yousefzada M,
Beer D,
Ludwig M.
et al.
Prospective Comparison of Handheld Ultrasound Devices from Different Manufacturers
with Respect to B-Scan Quality and Clinical Significance for Various Abdominal Sonography
Questions. Diagnostics 2023; 13: 3622
MissingFormLabel
- 6
Hempel D,
Sinnathurai S,
Haunhorst S,
Seibel A,
Michels G,
Heringer F.
et al.
Influence of case-based e-learning on studentsʼ performance in point-of-care ultrasound
courses: a randomized trial. European journal of emergency medicine : official journal
of the European Society for. Emergency Medicine 2016; 23: 298-304
MissingFormLabel
- 7
Röhrig S,
Hempel D,
Stenger T,
Armbruster W,
Seibel A,
Walcher F.
et al.
[Which learning methods are expected for ultrasound training? Blended learning on
trial]. Anaesthesist 2014; 63: 745-752
MissingFormLabel
- 8
Gillispie V.
Using the Flipped Classroom to Bridge the Gap to Generation Y. Ochsner J 2016; 16: 32-36
MissingFormLabel
- 9
Stockwell BR,
Stockwell MS,
Cennamo M,
Jiang E.
Blended Learning Improves Science Education. Cell 2015; 162: 933-936
MissingFormLabel
- 10
Tolks D,
Schäfer C,
Raupach T,
Kruse L,
Sarikas A,
Gerhardt-Szép S.
et al.
An Introduction to the Inverted/Flipped Classroom Model in Education and Advanced
Training in Medicine and in the Healthcare Professions. GMS J Med Educ 2016; 33: Doc46
MissingFormLabel
- 11
Blank V,
Strobel D,
Karlas T.
Digital Training Formats in Ultrasound Diagnostics for physicians: What options are
available and how can they be successfully integrated into current DEGUM certified
course concepts?. Ultraschall Med 2022; 43: 428-434
MissingFormLabel
- 12
McLaughlin JE,
Roth MT,
Glatt DM,
Gharkholonarehe N,
Davidson CA,
Griffin LM.
et al.
The flipped classroom: a course redesign to foster learning and engagement in a health
professions school. Acad Med 2014; 89: 236-243
MissingFormLabel
- 13
Hoffmann B,
Blaivas M,
Abramowicz J,
Bachmann M,
Badea R,
Braden B.
et al.
Medical Student Ultrasound Education, a WFUMB Position Paper, Part II. A consensus
statement of ultrasound societies. Med Ultrason 2020; 22: 220-229
MissingFormLabel
- 14
Dietrich CF,
Hoffmann B,
Abramowicz J,
Badea R,
Braden B,
Cantisani V.
et al.
Medical Student Ultrasound Education: A WFUMB Position Paper, Part I. Ultrasound Med
Biol 2019; 45: 271-281
MissingFormLabel
- 15
Cantisani V,
Dietrich C,
Badea R,
Dudea S,
Prosch H,
Cerezo E.
et al.
EFSUMB Statement on Medical Student Education in Ultrasound [long version]. Ultrasound
International Open 2016; 02: E2-E7
MissingFormLabel
- 16
Hoppmann RA,
Mladenovic J,
Melniker L,
Badea R,
Blaivas M,
Montorfano M.
et al.
International consensus conference recommendations on ultrasound education for undergraduate
medical students. The Ultrasound Journal 2022; 14: 31
MissingFormLabel
- 17
Dettmer S,
Barkhausen J,
Volmer E,
Mentzel HJ,
Reinartz S,
Voigt F.
et al.
White Paper: Radiology Curriculum for Undergraduate Medical Education in Germany and
Integration into the NKLM 2.0. Rofo 2021; 193: 1294-1303
MissingFormLabel
- 18
Bundesvereinigung K.
Mehr Flexibilität bei Teilnahme an Ultraschallkursen KBV.de2021 [cited 2024 12.02].
Available from: https://www.kbv.de/html/1150_54959.php
MissingFormLabel
- 19
Ruiz JG,
Mintzer MJ,
Leipzig RM.
The impact of E-learning in medical education. Acad Med 2006; 81: 207-212
MissingFormLabel
- 20
Soni VD.
Global Impact of E-learning during COVID 19. SSRN Electronic Journal 2020; 12
MissingFormLabel
- 21
Lien WC,
Lin P,
Chang CH,
Wu MC,
Wu CY.
The effect of e-learning on point-of-care ultrasound education in novices. Med Educ
Online 2023; 28: 2152522
MissingFormLabel
- 22
Rampton V,
Mittelman M,
Goldhahn J.
Implications of artificial intelligence for medical education. The Lancet Digital
Health 2020; 2: e111-e112
MissingFormLabel
- 23
Tarique U,
Tang B,
Singh M,
Kulasegaram KM,
Ailon J.
Ultrasound Curricula in Undergraduate Medical Education: A Scoping Review. J Ultrasound
Med 2018; 37: 69-82
MissingFormLabel
- 24
Moher D,
Hopewell S,
Schulz KF,
Montori V,
Gøtzsche PC,
Devereaux PJ.
et al.
CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel
group randomised trials. Bmj 2010; 340: c869
MissingFormLabel
- 25
Höhne E,
Recker F,
Dietrich CF,
Schäfer VS.
Assessment Methods in Medical Ultrasound Education. Front Med (Lausanne) 2022; 9:
871957
MissingFormLabel
- 26
Weimer J,
Dionysopoulou A,
Strelow K-U,
Buggenhagen H,
Weinmann-Menke J,
Dirks K.
et al.
Undergraduate ultrasound training: prospective comparison of two different peer assisted
course models on national standards. BMC Medical Education 2023; 23: 513
MissingFormLabel
- 27 DEGUM e. V. & Keim et al. Curriculum Abdomen DEGUM.de: DEGUM; 2013 [cited 2022 10.10.].
Available from: https://www.degum.de/fachgebiete/sektionen/innere-medizin/kurse/curriculum-abdomen.html
MissingFormLabel
- 28
Puthiaparampil T,
Rahman MM.
Very short answer questions: a viable alternative to multiple choice questions. BMC
Medical Education 2020; 20: 141
MissingFormLabel
- 29
Hofer M,
Kamper L,
Sadlo M,
Sievers K,
Heussen N.
Evaluation of an OSCE assessment tool for abdominal ultrasound courses. Ultraschall
Med 2011; 32: 184-190
MissingFormLabel
- 30
Arroyo-Morales M,
Cantarero-Villanueva I,
Fernández-Lao C,
Guirao-Piñeyro M,
Castro-Martín E,
Díaz-Rodríguez L.
A blended learning approach to palpation and ultrasound imaging skills through supplementation
of traditional classroom teaching with an e-learning package. Man Ther 2012; 17: 474-478
MissingFormLabel
- 31
Stoehr F,
Yang Y,
Müller L,
Gerstenmeier P,
Pinto dos Santos D,
Dietz P.
et al. A blended learning approach for teaching thoracic radiology to medical students:
a proof-of-concept study. Front Med. 10. 1272893
MissingFormLabel
- 32
Kusurkar RA,
Ten Cate TJ,
van Asperen M,
Croiset G.
Motivation as an independent and a dependent variable in medical education: A review
of the literature. Medical Teacher 2011; 33: e242-e262
MissingFormLabel
- 33
Weimer JM,
Rink M,
Vieth T,
Lauff J,
Weimer A,
Müller L.
et al.
Development and evaluation of a point-of-care ocular ultrasound curriculum for medical
students – a proof-of-concept study. BMC Med Educ 2023; 23: 723
MissingFormLabel
- 34
Hempel D,
Haunhorst S,
Sinnathurai S,
Seibel A,
Recker F,
Heringer F.
et al.
Social media to supplement point-of-care ultrasound courses: the “sandwich e-learning”
approach. A randomized trial. Crit Ultrasound J 2016; 8: 3
MissingFormLabel
- 35
Beaulieu Y,
Laprise R,
Drolet P,
Thivierge RL,
Serri K,
Albert M.
et al.
Bedside ultrasound training using web-based e-learning and simulation early in the
curriculum of residents. Critical Ultrasound Journal 2015; 7: 1
MissingFormLabel
- 36
Heiberg J,
Hansen LS,
Wemmelund K,
Sørensen AH,
Ilkjaer C,
Cloete E.
et al.
Point-of-Care Clinical Ultrasound for Medical Students. Ultrasound Int Open 2015;
1: E58-E66
MissingFormLabel
- 37
Vallée A,
Blacher J,
Cariou A,
Sorbets E.
Blended Learning Compared to Traditional Learning in Medical Education: Systematic
Review and Meta-Analysis. J Med Internet Res 2020; 22: e16504
MissingFormLabel
- 38
Nagaraj C,
Yadurappa SB,
Anantharaman LT,
Ravindranath Y,
Shankar N.
Effectiveness of blended learning in radiological anatomy for first year undergraduate
medical students. Surg Radiol Anat 2021; 43: 489-496
MissingFormLabel
- 39
Weimer AM,
Berthold R,
Schamberger C.
et al.
Digital Transformation in Musculoskeletal Ultrasound: Acceptability of Blended Learning.
Diagnostics (Basel) 2023; 13: 3272
MissingFormLabel
- 40
Michael D,
Renate M-P.
The role of structure, patterns, and people in blended learning. The Internet and
Higher Education 2005; 8: 111-130
MissingFormLabel
- 41
Bylieva D,
Lobatyuk V,
Safonova A,
Rubtsova A.
Correlation between the Practical Aspect of the Course and the E-Learning Progress.
Education Sciences 2019; 9: 167
MissingFormLabel
- 42
Almarzooq ZI,
Lopes M,
Kochar A.
Virtual Learning During the COVID-19 Pandemic: A Disruptive Technology in Graduate
Medical Education. J Am Coll Cardiol 2020; 75: 2635-2638
MissingFormLabel
- 43
Kaiser U,
Dropco I,
Reuthner K,
Ertl M,
Schlitt HJ,
Herr W.
et al.
Wireless handheld focused ultrasound in student teaching during the COVID-19 pandemic:
Initial results of a pilot study 1. Clinical Hemorheology and Microcirculation 2023;
85: 297-305
MissingFormLabel
- 44
Stoehr F,
Müller L,
Brady A,
Trilla A,
Mähringer-Kunz A,
Hahn F.
et al.
How COVID-19 kick-started online learning in medical education-The DigiMed study.
PLoS One 2021; 16: e0257394
MissingFormLabel
- 45
Stoehr F,
Müller L,
Brady AP,
Catalano C,
Mildenberger P,
Mähringer-Kunz A.
et al.
Online teaching in radiology as a pilot model for modernizing medical education: results
of an international study in cooperation with the ESR. Insights Imaging 2021; 12:
141
MissingFormLabel
- 46
Höhne E,
Recker F,
Schmok E,
Brossart P,
Raupach T,
Schäfer VS.
Conception and Feasibility of a Digital Tele-Guided Abdomen, Thorax, and Thyroid Gland
Ultrasound Course for Medical Students (TELUS study). Ultraschall Med 2023; 44: 194-202
MissingFormLabel
- 47
Clevert DA,
Jung EM,
Weber MA,
Lerchbaumer MH,
Willinek W,
Fischer T.
Concepts in the Establishment of Interdisciplinary Ultrasound Centers: The Role of
Radiology. Rofo. 2022; 194: 1322-1332
MissingFormLabel
- 48
Weimer JM,
Widmer N,
Strelow K-U,
Hopf P,
Buggenhagen H,
Dirks K.
et al.
Long-Term Effectiveness and Sustainability of Integrating Peer-Assisted Ultrasound
Courses into Medical School – A Prospective Study. Tomography 2023; 9: 1315-1328
MissingFormLabel
- 49
Wüstner M,
Radzina M,
Calliada F,
Cantisani V,
Havre RF,
Jenderka KV.
et al.
Professional Standards in Medical Ultrasound – EFSUMB Position Paper (Long Version)
– General Aspects. Ultraschall Med 2022; 43: e36-e48
MissingFormLabel
- 50
Cantisani V,
Jenssen C,
Dietrich CF,
Ewertsen C,
Piscaglia F.
Clinical Practice Guidance and Education in Ultrasound: Evidence and experience are
two sides of one coin!. Ultraschall Med 2022; 43: 7-11
MissingFormLabel
- 51
Neubauer R,
Bauer CJ,
Dietrich CF,
Strizek B,
Schäfer VS,
Recker F.
Evidence-based Ultrasound Education? – A Systematic Literature Review of Undergraduate
Ultrasound Training Studies. Ultrasound Int Open. 2024 10(continuous publication).
MissingFormLabel
- 52
Dietrich CF,
Sirli RL,
Barth G,
Blaivas M,
Daum N,
Dong Y.
et al. Student ultrasound education – current views and controversies. Ultraschall
Med. 2024
MissingFormLabel
- 53
Weimer J,
Ruppert J,
Vieth T,
Weinmann-Menke J,
Buggenhagen H,
Künzel J.
et al.
Effects of undergraduate ultrasound education on cross-sectional image understanding
and visual-spatial ability – a prospective study. BMC Med Educ 2024; 24: 619
MissingFormLabel
- 54
Carstensen SMD,
Just SA,
Velander M,
Konge L,
Hubel MS,
Rajeeth Savarimuthu T.
et al. E-learning and practical performance in musculoskeletal ultrasound: a multicenter
randomized study. Rheumatology (Oxford). 2023 62. 3547-3554
MissingFormLabel
- 55
Haskins SC,
Feldman D,
Fields KG,
Kirksey MA,
Lien CA,
Luu TH.
et al.
Teaching a Point-of-Care Ultrasound Curriculum to Anesthesiology Trainees With Traditional
Didactic Lectures or an Online E-Learning Platform: A Pilot Study. J Educ Perioper
Med 2018; 20: E624
MissingFormLabel