Cognitive Style and Mobile Technology in E-learning in Undergraduate Medical Education

Study Overview
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Brief Summary
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New designs of 6-year undergraduate medical education (UME) in Taiwan mainly include (1) integral curricula of body organ system, (2) multiple methods of clinical teaching and assessment, and (3) generalism in UME. Accompany with decreasing educational hours in the classrooms and hospital, essential but minor components of primary healthcare such as ophthalmology and otolaryngology-head and neck surgery (ORL-HNS) is disproportionately under-represented in UME. Novel medical education stresses on enabling self-directory learning and increasing learning hours outside the classrooms. Accordingly, we hypothesize that innovations in educational technology can enhance the learning outcomes of ORL-HNS. This study is aimed to determine whether mobile technology in e-learning (M-TEL) is an effective tool for the instruction of ORL-HNS and to compare effects of different cognitive styles on learning outcomes of M-TEL with various modules of medical education. This is a randomized controlled trial. We will recruit 60 UME students without previous training in ORL-HNS to undergo the Group Embedded Figures Test to determine their cognitive styles such as field dependence or field-independence. After blinded randomization, students are instructed on two modules of emergent ORL-HNS disorders, using either a standard e-learning of text-figure Power Point show or an interactive multimedia module. Subjects are evaluated on emergent ORL-HNS disorders using text-based assessment and multimedia assessment take place prior to and following instruction. After 7 days later, they will be assessed using global satisfaction score and AttrakDiff2 questionnaire. We anticipate that this study can confirm M-TEL can enhance the efficiency of the instruction of ORL-HNS and understand differences in learning outcomes of M-TEL with various modules of medical education between field dependence and filed independence using this platform.

Detailed Description
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Background: New designs of 6-year undergraduate medical education (UME) mainly include (1) integral curricula of body organ system, (2) multiple methods of clinical teaching and assessment, and (3) generalism in UME. UME is meant to enable graduates to become undifferentiated general physicians. Accompany with decreasing educational hours in the classrooms and hospital, essential but minor components of primary healthcare such as ophthalmology and otolaryngology-head and neck surgery (ORL-HNS) is disproportionately under-represented in UME. In Canada, substantial downstream effects on managing ORL-HNS problems have been noted in family medicine residents. In order to improve learning insufficiency and enhance clinical competency without increasing extra-hours in the classrooms and hospitals, novel medical education stresses on enabling self-directory learning and increasing learning hours outside the classrooms. Accordingly, we hypothesize that innovations in educational technology can enhance the learning outcomes of ORL-HNS. Purposes: This study is aimed to determine whether mobile technology in e-learning (M-TEL) is an effective tool for the instruction of ORL-HNS and to compare effects of different cognitive styles on learning outcomes of M-TEL with various modules of medical education. Material and Methods: This is a randomized controlled trial. Firstly, we have been setup a e-learning platform of the Top 10 emergent ORL-HNS disorders with translating into an application (APP) function that can execute in mobile devices. Secondly, we will recruit 60 UME students without previous training in ORL-HNS to undergo the Group Embedded Figures Test to determine their cognitive styles such as field dependence or field-independence. After blinded randomization, students are instructed on two modules of emergent ORL-HNS disorders, using either a standard e-learning of text-figure Power Point show or an interactive multimedia module. Subjects are evaluated on emergent ORL-HNS disorders using a text-based assessment and a multimedia assessment take place prior to and following instruction. Anticipating Outcome: This study can (1) establish a M-TEL of ORL-HNS that can deliver an innovatively mobile e-learning to supplement the deficiency of the classroom hours, (2) confirm M-TEL can enhance the efficiency of the instruction of ORL-HNS, and (3) understand differences in learning outcomes of M-TEL with various modules of medical education between field dependence and filed independence using this platform.

Official Title
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Cognitive Style and Mobile Technology in E-learning in Undergraduate Medical Education- A Randomized Controlled Trial of Otolaryngology-head and Neck Surgery

Conditions
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Medical Education

Intervention / Treatment
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* Other: mobile technology of e-learning (M-TEL)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age > 20 years old; UME students (defined as the three or four years of medical school training). Exclusion Criteria: Previous ORL-HNS training; Declining to participate.

Ages Eligible for Study
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Minimum Age: 20 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: This study was a prospective randomized controlled trial.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: interactive multimedia module<br>Subjects allocated to this experimental group will receive an intervention of mobile technology of e-learning (M-TEL) using the interactive multimedia (IM) module consist of integrated text, images, and small game tests (intervention) for 100 minutes. The module is a non-linearity of learning with interaction (student-based choice and pop-up feedback). This context has been adjusted to the same level to that of the PPS module. | Other: mobile technology of e-learning (M-TEL)<br>* UME students learn the Top 10 emergent ORL-HNS disorders using the M-TEL including the IM module or the PPS module.<br>|
| Active Comparator: Power Point show module<br>Subjects allocated to this experimental group will receive an intervention of mobile technology of e-learning (M-TEL) using the Power Point show (PPS) module consist of integrated text, images, and audio (intervention) for 100 minutes. The module is a linear learning without interaction. This context has been adjusted to the same level to that of the IM module. | Other: mobile technology of e-learning (M-TEL)<br>* UME students learn the Top 10 emergent ORL-HNS disorders using the M-TEL including the IM module or the PPS module.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage Change in Multiple-choice Question (MCQ) Scores | Subjects will undergo the duplicated 15-minute MCQ tests before after the M-TEL Subjects will undergo the duplicated 15-minute MCQ tests 15 minutes before the M-TEL intervention with either the IM module or the PPS module and immediately after the M-TEL intervention. | before and immediately after the M-TEL intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage Change in Multimedia Situation Test (MST) Scores | Subjects will undergo the duplicated 15-minute MST tests 15 minutes before the M-TEL intervention with either the IM module or the PPS module and immediately after the M-TEL intervention. | before and immediately after the M-TEL intervention | 
| Global Satisfaction Score | Global satisfaction score is measured using a visual analogue scale from 0 (very dissatisfied) to 10 (very satisfied) after 7 days post M-TEL. | 7 days after the M-TEL intervention | 
| AttrakDiff2 Questionnaire: Pragmatic Quality Score | For more delicately evaluate the acceptance of technical innovations, we will assess user experience using the AttrakDiff2. AttrakDiff2 is developed as a tool by Hassenzahl's research group to be able to quantify attractive, identifiable, stimulating, and pragmatic qualities. The tool consists of 28 seven-step items whose poles are opposite adjectives (e.g. confusing - clear, unusual - ordinary, good - bad). Each set of adjective items is ordered into a scale of intensity. Each of the mean values of an item group creates a scale value for pragmatic quality (PQ), hedonic stimulation (HQ-S), hedonic identification (HQ-I), and attractiveness (ATT) (range: -3-3). | 7 days after the M-TEL intervention | 
| AttrakDiff2 Questionnaire: Hedonic Stimulation | For more delicately evaluate the acceptance of technical innovations, we will assess user experience using the AttrakDiff2. AttrakDiff2 is developed as a tool by Hassenzahl's research group to be able to quantify attractive, identifiable, stimulating, and pragmatic qualities. The tool consists of 28 seven-step items whose poles are opposite adjectives (e.g. confusing - clear, unusual - ordinary, good - bad). Each set of adjective items is ordered into a scale of intensity. Each of the mean values of an item group creates a scale value for pragmatic quality (PQ), hedonic stimulation (HQ-S), hedonic identification (HQ-I), and attractiveness (ATT) (range: -3-3). | 7 days after the M-TEL intervention | 
| AttrakDiff2 Questionnaire: Hedonic Identification | For more delicately evaluate the acceptance of technical innovations, we will assess user experience using the AttrakDiff2. AttrakDiff2 is developed as a tool by Hassenzahl's research group to be able to quantify attractive, identifiable, stimulating, and pragmatic qualities. The tool consists of 28 seven-step items whose poles are opposite adjectives (e.g. confusing - clear, unusual - ordinary, good - bad). Each set of adjective items is ordered into a scale of intensity. Each of the mean values of an item group creates a scale value for pragmatic quality (PQ), hedonic stimulation (HQ-S), hedonic identification (HQ-I), and attractiveness (ATT) (range: -3-3). | 7 days after the M-TEL intervention | 
| AttrakDiff2 Questionnaire: Attractiveness | For more delicately evaluate the acceptance of technical innovations, we will assess user experience using the AttrakDiff2. AttrakDiff2 is developed as a tool by Hassenzahl's research group to be able to quantify attractive, identifiable, stimulating, and pragmatic qualities. The tool consists of 28 seven-step items whose poles are opposite adjectives (e.g. confusing - clear, unusual - ordinary, good - bad). Each set of adjective items is ordered into a scale of intensity. Each of the mean values of an item group creates a scale value for pragmatic quality (PQ), hedonic stimulation (HQ-S), hedonic identification (HQ-I), and attractiveness (ATT) (range: -3-3). | 7 days after the M-TEL intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cognitive style, e-learning, mobile technology, randomized controlled trial, otolaryngology-head and neck surgery