Assessment of a new e-learning system on thorax, trachea, and lung ultrasound

Abstract

Background. Lung ultrasound has become an emerging tool in acute and critical care medicine. Combined theoretical and hands-on training has been required to teach ultrasound diagnostics. Current computer technology allows for display, explanation, and animation of information in a remote-learning environment. Objective. Development and assessment of an e-learning program for lung ultrasound. Methods. An interactive online tutorial was created. A prospective learning success study was conducted with medical students using a multiple-choice test (Trial A). This e-learning program was used as preparation for a certified course followed by an evaluation of trained doctors (Trial B) by linear analogue scales. Pretests were compared with postcourse tests and sustainability tests as well as a posttest of a one-day custom classroom training. Results. In Trial A, during the learning success study (n = 29), the increase of correct answers was 11.7 to 17/20 in the post-test and to 16.6/20 in the sustainability test (relative change 45.1%, P < 0.0001). E-learning almost equalled scores of classroom-based training regarding gain and retention of factual knowledge. In Trial B, nineteen participating doctors found a 79.5% increase of knowledge (median, 95% CI: 69%; 88%). Conclusion. The basics of lung ultrasound can be taught in a highly effective manner using e-learning.

Figure 1

Flow diagram of all study participants. The classroom training cohort was part of the THOLUUSE study (with permission [14]).

Figure 2

Evaluation of the online tutorials by lung ultrasound experts (n = 9, members of Volpicelli et al. [8]). Experts revised as peer group the e-learning by grading the content within a data sheet blinded to each other. Questions aimed to assess key questions: A: completeness? B: precision? C: sufficient as prelearning? D: would you use it at your own training programme?

Figure 3

Comparison of two learning strategies: e-Learning versus custom classroom training. Absolute score indicates results of a pre- and posttest multiple choice questionnaire including 20 knowledge or image questions. Left of vertical line: results of learning success of a one-day presence only training on lung ultrasound “THOLUUSE” including 50% hands-on of (n = 54) medical doctors without E-Learning (taken from Breitkreutz et al. [14]). Right of dashed line: learning with e-learning but without custom classroom or hands-on training. E-Learning access was available within a learning phase of 4 weeks followed by a break without access of 2 weeks and completion with a sustainability test within the 7th week, results of n = 29 medical students. E-Learning was as effective as presence training regarding knowledge gain. (Boxslots contain median; line, box with 25/75 percentile, whiskers 5/95%, outliers, plus sign: mean), NS: not significant.

Figure 4

Self-evaluation of time spent with the online tutorial. A: n = 14; medical students after learning success study using survey monkey. B: n = 13; postgraduate medical doctors as part of the VAS questionnaires using paper-based questionnaires.

Figure 5

Self-evaluation at a discrete scale (0–10) of the online tutorial after completion, (a): of the learning success study by n = 19 medical students using Survey Monkey. 1: organization of the E-Learning, 2: own prior knowledge in lung ultrasound, 3: web-CT platform comfort, 4: own motivation, 5: general impression, 6: own learning success, (b): of n = 34 medical doctors after completion of preparation of the THOLUUSE training prelearning. Results of questions were grouped into areas of interest.1: personal effort, 2: scientific contents, 3: technical feasibility, 4: own learning success.