Evidence for a case-based module in the low-resource setting to teach ectopic pregnancy management

Abstract

Introduction: Case-based learning (CBL) utilizes authentic clinical cases that connect theory to practice. CBL has been shown to result in deeper learning and high engagement of adult learners. An open-source, web-based CBL module was created to help learners develop the cognitive foundation of ectopic pregnancy management in the low-resource setting. We present psychometric evidence that supports the use of this web-based CBL in the low-resource setting.

Methods: The case scenario comprising 20 topics in ectopic pregnancy management was created by an Ethiopian team member and hosted on an interactive web-based platform. The module was reviewed by Ethiopian, Cameroonian, and US surgeons and OB/GYN team members for content, relevance, and clarity, followed by a psychometrician for clarity, bias, relevance, and alignment. Twenty participants (3-Mbingo Baptist Hospital-Cameroon, 6-Soddo Christian Hospital-Ethiopia, 3-Southern Illinois University (SIU), and 8-University of Michigan (UM)) then completed the module. Four attending surgeons (2 OB/GYN, 2 general surgery) were designated experts while 10 medical students and 6 residents were designated novices. The module included a 10-item dichotomously scored pre-test, the CBL content, and the same, but shuffled, post-test. Pre- and post-test summed scores were compared using paired Student's t-tests, while differences in scores across participants' experience levels and sites were analyzed using a many-facet Rasch model.

Results: Findings indicated a statistically significant improvement in participants' mean summed scores from pre-test (M = 6.7, SD = 2.2) to post-test (M = 9.0, SD = 1.5), t(20) = - 4.76, P < 0.0001 and confirmed by Rasch analysis, P < 0.001. An adequate distribution of difficulty was demonstrated and 80% of questions had high discrimination value between experts and novices, d = | 0.87, 1.40 |. There was no difference in scores across specialties. Following the module, expert scores (M = 9.7) were higher than novice scores (M = 9.0), but the difference was not statistically significant.

Conclusion: Our findings suggest that using a web-based CBL module could be used to effectively improve understanding of the management of ectopic pregnancy in the low-resource setting, especially for nascent surgeons. The concept of a web-based CBL module has special attraction in the low-resource setting as it may target the adult surgical learner in remote regions where established technologies and existing experts are unavailable.

Keywords: Case-based learning; Education; Global surgery; Laparoscopy; Low-resource setting; Sub-Saharan Africa.

Fig. 1

ALL-SAFE statement of purpose African Laparoscopic Learners for Safe Advancement for Ectopic Pregnancy (ALL-SAFE) is a global partnership of academic medical centers in Cameroon, Ethiopia, and the United States.

Fig. 2

ALL-SAFE interactive case-based module Participants completed a case-based module and were assessed on cognitive learning through pre-tests and post-tests. The module was constructed to function in austere environments with reduced Internet connectivity. The case scenario included twenty questions like this.

Fig. 3

Learning Objectives Learning objectives for the cognitive portion of the ectopic pregnancy module with Bloom taxonomy and Miller's levels.

Fig. 4

Mean pre- and post-module test scores for all participants, n = 20 The mean pre-module test score was 6.7, with a standard deviation of 2.2. The mean post-module test score was 9.0 (SD 1.5). The pre- and post-module means have a statistically significant difference (P < 0.0001).