A study of how using an interactive multimedia e-book improves teachers’ ability to teach evidence-based medicine, depending on their seniority v1
Authors: T Mm , Chen Chih-Jen 
Published: October 2019

Background The role of the electronic book (e-book) is a useful adjunct to traditional teaching methods. Our aim is to study the use of the e-book for teaching effects. Methods This study was conducted from September 1, 2016 to October 31, 2017. An online e-book includedan introduction tothebasic conceptsofEBM; EBMdatabases; databaseliterature searchesskills; critical appraisal.A repeatable answer-correct quiz to assess each of the learning objectives was available at the end of each topic. Problem sets were made for readers and were used for self-assessment purposes. They were presented in a multiple-choice question format, and readers could respond by clicking to answer the question.Another learning method (PowerPoint) was designed for use as a control group (S1 Appendix). The PowerPoint learning material was designed with the same contents as that of the e-book. It included thebasic conceptsofEBM, EBMdatabases, literature searchskills, critical appraisalmethods. In the PowerPoint presentation, the quiz questions were presented in a multiple-choice format but responses could not be elicited by clicking. Study Design Visiting staff teachers at Chang Gung Memorial Hospital (CGMH) were enrolled in this study. The teachers created a question and searched the electronicdatabases available at the CGMH before the study. They attempted to consolidate the evidence to come to a conclusion and make a recommendation. An assessment questionnaire was completed as a pretest data. We then gave them access to the e-book or PowerPoint presentation and encouraged them to practice using it. They re-examined the information they had written by searching, consolidating evidence, and correcting the recommendation. After this, the assessment questionnaires were completed. The study group utilized the e-book and the control group the PowerPoint presentation without the e-book. A randomized controlled trial was established with a 1:1 allocation ratio to assess the students before assigning them to the e-book or control group. Randomization was executed (allocation concealment) through central randomization performed by an independent randomizer (assistant). She used random assignment with a two-blocked design in the order of their entry into the study using http://www.randomizer.org. Assessment and Evaluation Theteachers’ skills were assessed through questionnaires modified from previous reports as well as a five-point Likert scale, both before and after the e-book or PowerPoint learning. [21]Teachers’ abilities were examined by pretest and post-learning questionnaire measurements. One month later, each teacher gave a 20–30 minute lesson on EBM based on the PowerPoint as a teaching material regarding the formulation of problems, database searching techniques, literature appraisal, level of evidence and recommendation for two to four students, who then assessed their teaching skills and ability. There were eight statements for the students to answer with the following options: strongly agree, agree, neutral, disagree, and strongly disagree. The eight statements were: “I am satisfied with this lesson,” “The teaching was of high quality,” “The teacher had a good attitude,” “This was a good teaching method,” “It helped my understanding,” “I was allowed to ask unlimited questions,” “The teacher listened to my questions,” and “It aroused my interest in EBM.” Validity and Reliability Content validity of the EBM skill survey was examined by three experts who had no involvement with the participants. They were asked to rate each item. The final survey included only the items with strong relevance. The internal consistency of all indexes was estimated using Cronbach’s α.[21-23] The questionnaire had a content validity index of 0.90, and Cronbach’s coefficient α of 0.801. Ethical Process The study was approved by the institutional review board of the ethics and clinical research committee of CGMH (104-9177B). All teachers and students assigned to the two groups provided their consent prior to participating in the study. To blind the statistician, the data was anonymous and the participants’ names on the questionnaires were removed before data analysis. Blinding the caregivers, data storage, the recruitment of participants, and data collection were conducted by a research assistant who had no assessment relationship with participants. Participants had the right to remove their data and consent at any time. Statistical Analysis The evaluation of EBM skills and teaching effects was conducted by comparing the t-tests of participants allocated to the e-book or the PowerPoint group. The teachers were divided into sub-groups according to the length of their clinical experience: less than 5 years, 5–10 years, and more than 10 years of experience. A p-value < 0.05 was considered statistically significant. The statistical analyses were performed using the Statistical Package for Social Science (SPSS, version 12) software.