E-Learning vs. E-Learning with Hands-on: An Experimental Study to Improve Clinical Skills
Authors: Diethei Daniel , Ertle Franz , Grundgeiger Tobias , Mengelkamp Christoph , Held Volker 
Published: September 2017

The training of healthcare staff is an important aspect in reducing adverse events related to medical devices. For medical devices, e-learning has been shown to be a successful method for knowledge acquisition (e.g., Grundgeiger et al, 2016). However, research addressed the learning of clinical skills to a lesser extent. Hands-on learning seems to be superior to conventional classroom learning when it comes to long-term-memory performance (e.g., Hearns, Miller, & Nelson, 2010). This study examined whether using a syringe pump while learning improves the skills to operate the pump, subjective confidence when using the pump, and knowledge about the pump compared to a training without the pump.

We tested two groups of nursing students. One group received training with an e-learning module and a syringe pump for hands-on practice (e-learning + pump, n = 25), whereas the other group used the e-learning module only (e-learning only, n = 26). In the first session, the participants were asked to conduct a 35-minute training session, followed by a questionnaire, a knowledge test, and a skills test. In a follow-up session, the tests were repeated but these results are not part of this abstract. Ethical approval was obtained from the local ethics committee and the participants gave their informed consent.

The independent variable was learning method and was manipulated between participants. One group was instructed to make use of a syringe pump placed next to the e-learning computer during the e-learning module (e-learning + pump). The second group did not have the syringe pump while learning (e-learning only). The main dependent variable was the number of tasks solved in the skills test. In addition, we investigated the participants’ subjective confidence in operating the syringe pump, their knowledge about the pump, and the amount of assistance that the participants needed to solve the tasks. Based on the literature, we expected that the e-learning + pump group would solve more tasks in the skill test, is more confident in using the pump, and would require less assistance compared to the e-learning only group.

The difference of the proportion of solved tasks in the skills test between e-learning + pump group and the e-learning only group was not significant. There was even a slight descriptive advantage for the e-learning only group. For the confidence rating, we observed no significant difference between the groups. In the knowledge test, the e-learning + pump group performed slightly better than the e-learning only group, but the difference was not statistically significant. To assess the amount of required assistance, we counted every sub-task for which a participant needed assistance, regardless of the amount of assistance given per sub-task. Again, there was no effect of the learning method.

The results suggest that, with the current study design, there is no benefit of having the device at hand. One may argue that the power of our study might have been too low to find a statistically significant difference between the learning methods. However, because our main independent variable indicated a trend in the opposite direction, we conclude that the current e-learning + pump training does not provide any benefits over e-learning only.

The null-effect found in the present study may be due to the split-attention effect. Participants in the e-learning + pump group were told to use the syringe pump combined with the e-learning application. Therefore, they had to switch between the e-learning application and the syringe pump in an unsteady manner to receive all of the relevant information. Considering the split-attention effect (Ayres & Sweller, 2014), switching back and forth might have increased the participants’ cognitive extraneous load (Sweller et al., 1998).

Although our results are somewhat unexpected, our study showed that “just” providing a device and instructing healthcare staff to use the device alongside a e-learning module does not improve learning outcomes. Based on the literature (Keers et al., 2013), however, there is a need to improve learning. Future studies should develop and evaluate innovative approaches to teach clinical skills in order to improve overall patient safety.