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Asynchronous vs didactic education: it’s too early to throw in the towel on tradition

Asynchronous vs didactic education: it’s too early to throw in the towel on tradition Background: Asynchronous, computer based instruction is cost effective, allows self-directed pacing and review, and addresses preferences of millennial learners. Current research suggests there is no significant difference in learning compared to traditional classroom instruction. Data are limited for novice learners in emergency medicine. The objective of this study was to compare asynchronous, computer-based instruction with traditional didactics for senior medical students during a week-long intensive course in acute care. We hypothesized both modalities would be equivalent. Methods: This was a prospective observational quasi-experimental study of 4th year medical students who were novice learners with minimal prior exposure to curricular elements. We assessed baseline knowledge with an objective pre-test. The curriculum was delivered in either traditional lecture format (shock, acute abdomen, dyspnea, field trauma) or via asynchronous, computer-based modules (chest pain, EKG interpretation, pain management, trauma). An interactive review covering all topics was followed by a post-test. Knowledge retention was measured after 10 weeks. Pre and post-test items were written by a panel of medical educators and validated with a reference group of learners. Mean scores were analyzed using dependent t-test and attitudes were assessed by a 5-point Likert scale. Results: 44 of 48 students completed the protocol. Students initially acquired more knowledge from didactic education as demonstrated by mean gain scores (didactic: 28.39% ± 18.06; asynchronous 9.93% ± 23.22). Mean difference between didactic and asynchronous = 18.45% with 95% CI [10.40 to 26.50]; p = 0.0001. Retention testing demonstrated similar knowledge attrition: mean gain scores −14.94% (didactic); -17.61% (asynchronous), which was not significantly different: 2.68% ± 20.85, 95% CI [−3.66 to 9.02], p = 0.399. The attitudinal survey revealed that 60.4% of students believed the asynchronous modules were educational and 95.8% enjoyed the flexibility of the method. 39.6% of students preferred asynchronous education for required didactics; 37.5% were neutral; 23% preferred traditional lectures. Conclusions: Asynchronous, computer-based instruction was not equivalent to traditional didactics for novice learners of acute care topics. Interactive, standard didactic education was valuable. Retention rates were similar between instructional methods. Students had mixed attitudes toward asynchronous learning but enjoyed the flexibility. We urge caution in trading in traditional didactic lectures in favor of asynchronous education for novice learners in acute care. Keywords: Medical student education, Emergency medicine, Computer based education, Asynchronous learning * Correspondence: [email protected] Department of Emergency Medicine, Harbor-UCLA Medical Center, 1000 W. Carson St., Box 21, Torrance 90509-2910, CA, USA David Geffen School of Medicine at University of California, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA Full list of author information is available at the end of the article © 2013 Jordan et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Jordan et al. BMC Medical Education 2013, 13:105 Page 2 of 8 http://www.biomedcentral.com/1472-6920/13/105 Background ACC are required to participate in an intensive, weeklong Methods of education continually evolve to meet the educational experience at the beginning of the fourth year. ever-changing needs of instructors and learners. Asyn- This course consists of didactic lectures, small-group chronous, computer-based instruction has become more interactive activities, procedural training on unembalmed prevalent in recent years. Asynchronous learning is a cadavers, full-scale human simulation of critical patient student centered instructional method where interac- management scenarios, and career development sessions. tions between teachers and learners occur independent Students in previous years have asked repeatedly for more of place and time [1]. This type of learning holds the po- hands-on time in the simulation, cadaver, and procedural tential for increased cost-effectiveness, greater flexibility, labs, but educators have struggled to increase this compo- self-directed pacing and review, and improved efficien- nent without compromising time spent on the acute care cy of educator resources [2,3]. These potential benefits core content that is essential to the students’ knowledge particularly apply to medical education where new dis- base to prepare them for both the interactive sessions and coveries are made daily, placing increasing demands on eventual patient management. In prior years, this standard educators and students to share knowledge despite in- curriculum was delivered in classroom lecture format at creased regulations of duty hours and costs. In post- the beginning of each day of the course. To address the graduate training programs, the prospect of including desire to expand the smaller group formats, we offered asynchronous learning modules to meet the conference asynchronous, computer-based instruction to deliver half attendance requirements set forth by the Accreditation of the core course content to our novice learners, thus Council for Graduate Medical Education (ACGME) [4] freeing up more time for hands-on and small group expe- is highly desirable. Additionally, in 2008, a report issued riences. We hypothesized that there would be no signifi- by the Macy Foundation highlighted the need for indi- cant difference between the two instructional methods. vidual practitioners to monitor and address their own The objectives of our study were to: (1) assess if senior learning to keep up with changes in medical practice [5]. medical students improve their medical knowledge with Asynchronous education can provide this opportunity, asynchronous, computer-based instruction and traditional thus has large appeal in the medical profession. didactic lectures to the same level during a one-week re- Most research surrounding computer based learning quired course in acute care; and (2) explore students’ atti- to date suggest that there is no significant difference be- tudes towards asynchronous and didactic instruction. tween traditional classroom-based and asynchronous, computer-based instruction. Randomized controlled tri- Methods als looking at the effectiveness of an asynchronous, com- Study setting and participants puter based course versus traditional classroom teaching All fourth-year medical students enrolled in the 2011–2012 of evidence based medicine found that computer-based ACC Foundations Course at the David Geffen School of learning was as effective at increasing a student’s know- Medicine at UCLA participated. This study was certified ledge as traditional classroom teaching [6,7]. A 2008 as exempt by the Institutional Review Board from the meta-analysis regarding internet based learning in the David Geffen School of Medicine at UCLA Office for health professions utilizing data from 76 studies con- Protection of Human Subjects. cluded that there was no significant difference in effect- iveness between traditional and internet based methods [8]. Other studies have been performed in infection con- Study design trol [9], neuroanatomy [10], and respiratory medicine This was a prospective, observational, quasi-experimental [11], which showed a similar effect between classroom curricular evaluation study. Pre- and post-test items were and asynchronous, computer-based instruction. There developed and revised by the authors (all were course are limited data on this comparison in acute care or faculty). Post-test questions differed from the pre-test emergency medicine (EM); however, a few studies questions to minimize recollection bias, but covered the looking at the instruction of emergency procedures via same topics. Items were randomly assigned, by our non- an online asynchronous format have yielded positive physician study coordinator, to be on either the pre- or results [12,13]. post-test. Both knowledge tests were carefully blue- At the David Geffen School of Medicine at the University printed to ensure each form contained an equal number of California, Los Angeles, fourth year students self-select of items of critical topics from each module, ensuring and enroll in one of five colleges based on their future car- content validity. Pre- and post-tests were found to be of eer choice or interest in the unique curricular offerings of comparable difficulty by utilizing a separate group of an individual college. The Acute Care College (ACC) is reference learners, emergency medicine interns, whose typically comprised of students who plan to specialize in mean pre-test score was 55.83% ± 15.51 and mean post- Anesthesiology, EM, or Critical Care. Students of the test score was 58.33% ± 11.68. This difference was not Jordan et al. BMC Medical Education 2013, 13:105 Page 3 of 8 http://www.biomedcentral.com/1472-6920/13/105 significant with a mean difference of −2.5% [−17.67 to computer-based modules (chest pain, EKG interpretation, 12.67]; p = 0.76. pain management, field trauma). Selection of mode of Further in depth analysis of the reference group found teaching was based on the desire to vary content and to that there was not a significant difference in perform- accommodate professor availability. To the best of our ance on pre-test questions covering asynchronous con- knowledge there was nothing inherent in the topics that tent and pre-test questions covering didactic content would make them more amenable to either method of de- with mean scores of 60.72% ± 19.84 and 53.13% ± 12.94 livery. The professors conducting the real-time sessions respectively with a mean difference of 7.60% [−5.07 to were the usual lecturers for the course and welcomed 20.25]; p = 0.20. There was also not a significant differ- audience participation. All had earned excellent to out- ence in performance of the reference group on post-test standing evaluations by students in prior years. Each lec- questions covering asynchronous and didactic content ture was 45 minutes in duration and was scheduled as the with mean scores of 65.63 ±17.36 and 48.21 ± 15.15 re- first activity of the morning. spectively with a mean difference of 17.41% [−0.66 to The asynchronous, computer-based modules consisted 35.48]; p = 0.57. Lastly the reference group did not show of two digitally recorded podcast lectures (chest pain a significant difference in performance between pre- and and acute pain management) by the same faculty who post-test questions covering asynchronous content gave them annually as “live” sessions in previous years (mean scores of 60.72 ± 19.84 and 65.63 ± 17.40 respect- and who were also highly rated by prior students. These ively, mean difference of 4.91% [−26.54 to 16.72]; p = lectures were assigned to this modality based on faculty 0.61) or didactic content (mean score of 53.13 ± 12.94 willingness to convert their usual lecture to an asyn- and 48.21 ± 15.15 respectively, mean difference of −4.91% chronous format. Both specifically highlighted concerns [−12.53 to 22.35]; p = 0.53). This comprehensive analysis that had been raised consistently by students in prior suggests that pre- and post-tests were of similar difficulty years. The third module (field trauma) was a video of for both asynchronous and didactic content. trauma cases and debriefings that was shown in previous Figure 1 depicts the flow of our study. On Day 1, each years as the didactic session, in which the creating professor participant provided demographic data (age, gender, and was present to answer questions and assure compliance. intended specialty), followed by a knowledge pre-test The final asynchronous module (EKG interpretation) was comprised of multiple choice single answer questions prepared specifically for asynchronous education. It con- about the core didactic topics (shock, acute abdomen, sisted of examples of EKGs with detailed analysis and ex- dyspnea, trauma, chest pain, EKG interpretation, and planations. This was similar to the format used when this pain management). topic had been delivered in the large group format. The standard curriculum on these topics was delivered All four asynchronous, computer-based modules were in either traditional classroom lecture format (shock, acute uploaded to the university’s educational website which abdomen, dyspnea, ED trauma) or via asynchronous, is familiar to all students. The website can be accessed DAY 1 Demographic Questionnaire and Cognitive Pre-Test DAY 2-5 DAY 2-5 Core Topics: Didactic Lectures Core Topics: Asynchronous Learning Shock, Acute Abdomen, Field Trauma, Dyspnea Chest Pain, EKGs, Pain, ED Trauma DAY 5 Interactive Group Review: Question-Answer Format DAY 5 Cognitive Post-Test and Attitudinal Survey DAY 70 Cognitive Retention Post-Test Figure 1 Study flowchart. Jordan et al. BMC Medical Education 2013, 13:105 Page 4 of 8 http://www.biomedcentral.com/1472-6920/13/105 Table 1 Student demographics remotely, allowing students to view the modules on their own time in the location of their choosing, including Total n = 44 their own personal or home computers. Additionally, Mean age (years) 25.8 students were allocated one daily block of unscheduled Female 16 time during the week where they had no structured ac- Male 28 tivities and could choose to use the time to complete the Intended specialty: asynchronous modules, ask for clarification from course Critical care 22 faculty, meet with mentors, or tend to personal matters. The medical school’s computer learning laboratory was Emergency medicine 15 reserved for their use throughout the course, and they Anesthesia 7 were also entitled to use university computers after Results reported as n or years. hours. The length of time spent on the asynchronous, computer-based modules was self-directed and unlim- Mean gain scores (relative to post scores) were −14.94% ited, and students had the option to go back and review (didactic); -17.61% (asynchronous). This was not signifi- the material at any time. While students were allowed to cantly different, with a mean difference of 2.67% ± 20.85, perform asynchronous learning in teams, each had to 95% CI [−3.66 to 9.02], p = 0.399. Mean scores for the re- log on to document enrollment in each module to re- tention test in the asynchronous group were lower than ceive course credit. pre-test scores, 51.99% ± 13.46 and 62% ±15.69 respect- On the final day (Day 5), faculty conducted a 1-hour ively. This difference was statistically significant with group interactive, question-answer review session equally amean difference of −10.02% ± 15.48, 95% CI [−14.73 covering both asynchronous and traditional topics. The to −5.32]; p = 0. Mean gain scores are depicted in Table 2. purpose of this review was to ensure that everyone had an Mean scores for pre, post, and retention testing are opportunity to clarify concepts and fill in gaps in know- depicted in Table 3. There was a significant difference in ledge on all subject matter. At the end of Day 5, students pre-test scores for asynchronous and didactic groups with took a multiple choice post-test to assess their knowledge mean scores of 62% ± 15.69 and 39.75% ± 13.29 respect- gain and completed a five-point Likert scale questionnaire ively with mean difference of 22.24% ± 22.06, 95% CI to assess attitudes toward asynchronous and didactic in- [15.53 to 28.95]; p = 0. struction. Ten weeks later, students again completed the Students had mixed attitudes towards asynchronous multiple choice post-test to assess knowledge retention, education (Figure 2). Students uniformly (95.8%) enjoyed during a regularly scheduled educational meeting. the flexibility afforded by asynchronous learning however, only 60.4% believed the asynchronous modules were edu- Data analysis cational. When asked which type of learning they pre- We calculated the percentage of correctly answered ferred, 39.6% indicated that asynchronous education was questions for each instructional method and computed a preferable for required didactics, 37.5% were neutral, and gain score by subtracting pre-test scores from post-test 23% preferred traditional lectures. scores. We compared instruction methods using a dependent t-test of mean gain scores. Data were ana- Discussion lyzed with IBM SPSS version 20 (IBM Software group, The results of this study suggest that asynchronous, Chicago, IL). computer-based instruction is not equivalent to didactic instruction of an acute care curriculum for novice Results learners. In a rapidly changing educational climate where All 48 students enrolled in the course consented to par- increasing constraints are placed on funding and time, ticipate in the study. 44 of 48 completed the study asynchronous, computer based instruction seems like an protocol. Four were absent during the administration of exciting alternative; however, like any new method, it the 10-week retention test and so their data were not in- Table 2 Mean gain scores cluded in the analysis. Demographic characteristics are displayed in Table 1. Pre test to post Post test to retention test % ± SD test % ± SD Mean gain in knowledge was 28.39% ± 18.06 for didactic Didactic 28.39 ± 18.06 −14.94 ± 18.73 instruction and 9.93% ± 23.22 for asynchronous instruc- tion. A two-tailed dependent t-test revealed a statistically Asynchronous 9.93 ± 23.22 −17.61 ± 17.12 significant mean difference between didactic and asyn- Mean difference% ± SD 18.45 ± 27.72 2.68 ± 20.85 chronous modalities of 18.46% with 95% CI [10.40 to 95% CI [10.40 to 26.50] [−3.66 to 9.02] 26.50]; p = 0.0001. Retention testing after 10 weeks dem- p value p = 0.0001 p = 0.399 onstrated similar knowledge attrition for both groups. Jordan et al. BMC Medical Education 2013, 13:105 Page 5 of 8 http://www.biomedcentral.com/1472-6920/13/105 Table 3 Mean test scores Our results contrast with much of the current litera- Pre test Post test Retention test ture that generally has found that asynchronous and di- %±SD %± SD %±SD dactic education are equivalent. We hypothesize that Didactic 39.75 ± 13.29 67.86 ± 11.99 52.92 ± 18.89 there are several factors that may account for this. First, students had a higher baseline knowledge of the asyn- Asynchronous 62 ± 15.69 69.63 ± 15.10 51.99 ± 13.46 chronous topics, as evidenced by a higher mean pre-test score. This finding was not demonstrated in the refer- lacks a thorough evidence based assessment. Asynchron- ence group. Therefore, the lack of gain seen with this ous learning requires a substantial investment of re- method may have been due partially to a ceiling effect. sources initially for product design, implementation, and This higher baseline knowledge may be due to prior monitoring, but offers long term benefits of saving in- education, though these students had received only min- structor time and reducing logistical planning for class- imal exposure to the studied content. Larger, multi- room space in subsequent years. Additionally, student institution studies may elucidate whether this finding is learning may be facilitated by allowing students to learn consistent. at a time, place, and setting convenient for them. Asyn- Additionally, while didactic education is considered to chronous learning can also free up time in a curriculum be a one-way transmission of material from teacher to for more hands on learning of topics that must be conducted learner, we cannot overlook the possibility of meaningful in a face-to-face manner. Despite these stated benefits, interaction between experts and learners during live lec- asynchronous learning may not be worth the investment if tures. This type of interaction, which allows for immedi- we do not find at least equivalency with current teaching ate clarification of concepts and extension of knowledge, methods. It is prudent to be wary of investing in a pro- may be particularly important for novice learners who gram that has not been fully evaluated. have relatively little exposure to the subject matter, such "I Found the Asynchronous Modules to be Educational." "I Enjoyed the Flexibility of the Asynchronous 18 Modules." 1 = Strongly Disagree 3 = Neutral 5 = Strongly Agree 1 = Strongly Disagree 3 = Neutral 5 = Strongly Agree Likert Scale Likert Scale "I Prefer a Traditional Didactic Lecture for Required "I Prefer Asynchronous Education for Required Topics." Topics." 0 0 12345 12345 1 = Strongly Disagree 3 = Neutral 5 = Strongly Agree 1= Strongly Disagree 3 = neutral 5 = Strongly Agree Likert Scale Likert Scale Figure 2 Results of attitudinal survey. Number of Responses Number of Responses Number of Responses Number of Response Jordan et al. BMC Medical Education 2013, 13:105 Page 6 of 8 http://www.biomedcentral.com/1472-6920/13/105 as our study population. Most rigorous studies on design that would require the learner to demonstrate under- factors for asynchronous “distance learning” education standing of information before moving on to the next can be found in the literature describing undergraduate step. Ready access to others on a discussion board might (college) education, and have emphasized the import- serve a similar purpose. ance of interaction amongst the peer learners and be- Students’ attitudes may also have contributed to our tween the instructors and students, that focuses on results. No educational method can succeed without a course content and learning issues. This “community of critical amount of learner “buy-in” and, as demonstrated inquiry” has a profound impact on learning outcomes by our attitudinal assessment, this study population, and satisfaction [14,15]. Increased interaction within while generally favorable, had mixed opinions regarding asynchronous modules, amongst peers and between asynchronous compared to didactic instruction. Current learners and instructors via a discussion board may yield literature on this topic does not always include learner more positive results for asynchronous learning, as it did attitudes towards various methods and whether they cor- in a study of EM house officers [16]. In our model, we relate with outcomes. To ensure success of asynchronous believed that we had provided students with the oppor- instruction, curriculum developers must identify why stu- tunity to seek feedback and ask questions by carving out dents may not have positive attitudes towards this modal- a designated time during their individual schedules for ity and create solutions to address these barriers. each day. In past years, we noted that some students felt Asynchronous learning may be a tool that is better frustrated by the rapid pace of traditional didactic learn- used as a complement to traditional education rather ing without an opportunity to clarify points individually. than a replacement, especially in the setting of EM. Some complained that the lectures had moved forward Blended learning that combines interactive didactics too quickly and that they wished they could have re- with asynchronous modules may be a successful method, peated the basics before attempting the more difficult capitalizing on the strengths of both techniques and material. Others indicated a need for unscheduled time minimizing the weaknesses [18]. The few studies in the during the business day to attend to matters such as field of EM support more of a blended model rather mentor meetings and personal issues. than favoring one or the other [19,20]. Many studies on asynchronous instruction in medical Lastly, though our study suggests that asynchronous education and healthcare focused on a single topic and didactic education may not be equivalent for know- [7,9-11,13]. Our study, while aimed at a single learner ledge acquisition, we did see similar knowledge attrition group, sought to impart information across a diverse after a period of time in both groups so that we cannot range of topics in acute care. We believe that the re- favor one method over the other in terms of retention of quired use of an interactive supplement to the independ- knowledge. Interestingly, mean retention scores for the ent learning modules in the form of specific face-to-face asynchronous group were lower than mean pre-test encounters or mandatory online teacher-moderated dis- scores. We did not find a significant difference between cussion boards would mitigate the difficulties inherent test items in our reference group. On the surface, it in mastering new information. Successful university pro- seems counterintuitive that students would lose more grams cited this as a key element when their asynchron- knowledge than they started out with. We postulate that ous learning course had a broad focus [14,15]. It is likely students may have faced some degree of “information that frequent knowledge checks and student account- overload” given the intense knowledge acquisition across ability would create a positive learning condition, and several different topics in a relatively short time frame. could provide an avenue for clarification that might Additionally, students who were complete novices may otherwise seem daunting for a novice learner. have been able to answer the questions from a simpler Our results may also indicate a mismatch between edu- perspective. As they acquired more knowledge during their clinical encounters and extended their experience, cational methods and learner needs. While asynchronous instruction does appeal to today’s millennial learner’spref- the objective test items may have evoked a more compli- erence for flexibility, use of technology, and audio-visual cated thought process that extended beyond the straight- forward answers that were more obvious when the stimulation, it also places a significant amount of responsi- bility and need for independent monitoring on the learner. subject material represented the majority of their under- This self-directed approach may be more difficult for the standing at the beginning of the academic year. Improv- ing knowledge retention through various instructional millennial learner who typically has had a high level of parental and teacher involvement. These learners thrive methods is another area that warrants further research. on immediate delivery of knowledge and formative feed- back to maintain focus and enhance learning [17]. In Limitations and future directions modules such as those in our course, this could come in This study took place at one institution, so the results the form of frequent formative quizzes and “hard stops” may be difficult to generalize. It is particularly difficult Jordan et al. BMC Medical Education 2013, 13:105 Page 7 of 8 http://www.biomedcentral.com/1472-6920/13/105 to perform a randomized, controlled study in the educa- Competing interests The authors declare that they have no competing interests. tional setting. Because this was a required course, we felt it would be unethical to randomize students to different Authors’ contributions experiences. Additionally, it is possible that our inter- JJ is the principal investigator for this study and participated in study design, served as core faculty, wrote test items, and drafted the manuscript. AJ is active review on Day 5 could have accounted for the lack responsible for maintaining and analyzing data for the study. SC served as of difference between groups in the post-test. It may core faculty wrote test items, and contributed to the manuscript. PD served have been more telling if we had conducted the post-test as core faculty, wrote test items, and contributed to the manuscript. TS served as core faculty and contributed to the manuscript. WC supervised all prior to this session. It is also important to note that the aspects of the study and edited the manuscript. All authors read and term “asynchronous” applies to an enormous variety of approved the final manuscript. educational modalities - from podcasts to interactive Authors’ information games. We urge caution in generalizing our results to all JJ is a fellow in Medical Education at Harbor-UCLA Department of formats of asynchronous instruction. Our curriculum in- Emergency Medicine and Director of Asynchronous Learning for the Acute cluded a variety of teaching modalities. It is likely that Care College at UCLA School of Medicine. AJ is a research associate and the coordinator for the Acute Care College at UCLA School of Medicine. SC is each student could find something appealing in this mix, assistant professor of Emergency Medicine at University of California, Davis. however, the superiority of any one modality could not During this project, he was a Medical Education fellow at Harbor-UCLA be determined with this approach. We felt such a varied Emergency Medicine and Director of Simulation Education for the Acute Care College at UCLA. PD is Professor of Medicine at UCLA School of curriculum was more representative of our existing Medicine and Director of Preclinical Education for the Acute Care College. TS course and chose to evaluate it as a whole. is Assistant Professor of Medicine at UCLA School of Medicine and Director Despite these limitations, our study does provide signifi- of Continuing Education for the Acute Care College. WC is a Professor of Medicine and Chair of the Acute Care College at UCLA School of Medicine; cant results that should encourage the medical education Director of Medical Education, and Director of the Fellowship in Medical community to further examine the merits of traditional Education at Harbor-UCLA Department of Emergency Medicine. lectures and asynchronous educational methods. We urge educators to select the appropriate method based on their Acknowledgements The study was supported by Acute Care College funds from the Office of the learners’ needs. Asynchronous, computer-based instruc- Dean and the Department of Educational Development and Research at the tion still has the potential for significant value as a cur- David Geffen School of Medicine at the University of California, Los Angeles. ricular component. However, we caution against “jumping Presentations on the asynchronous band-wagon” and closing the door on traditional methods that have withstood the test of 1. Oral Research Presentation at the Plenary Session of the Academic time. There are still many questions left unanswered. Assembly: Council of Residency Directors (CORD), April 2012, Atlanta, GA; More research is required, perhaps beginning with a quali- 2. Oral Research Presentation at the Society: Academic Emergency tative exploration, to define the value and application of Medicine (SAEM) Western Regional Forum, March 2012, Las Vegas, NV; asynchronous education in the setting of EM and acute 3. Moderated poster: SAEM Annual Meeting, May 2012, Chicago, IL. care, particularly when the learners are novices. Proper Author details attention in selecting effective asynchronous topics, me- Department of Emergency Medicine, Harbor-UCLA Medical Center, 1000 W. thods, and targeting appropriate learner groups should be Carson St., Box 21, Torrance 90509-2910, CA, USA. David Geffen School of Medicine at University of California, 10833 Le Conte Avenue, Los Angeles, CA further elucidated. Inclusion of built-in interaction with 90095, USA. Department of Emergency Medicine, University of California, peers and faculty in a virtual or physical environment may Davis Medical Center, 2315 Stockton Boulevard, Sacramento, CA 95817, USA. enhance the utility of asynchronous instruction. Department of Emergency Medicine, Olive View-UCLA Medical Center, 14445 Olive View Drive, Sylmar, CA 91342, USA. Los Angeles Biomedical Research Center at Harbor-UCLA, Torrance, USA. Conclusion Received: 21 February 2013 Accepted: 18 July 2013 Published: 8 August 2013 Asynchronous, computer-based modules alone were not equivalent to traditional lectures for novice learners of References acute care topics. Didactic education was valuable in this 1. Worthington T: Synchronizing Asynchronous Learning. Collections: Australian setting for immediate mastery of content, although reten- National University Digital; 2013. 2. Sener J: Why online education will attain full scale. 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Ashton A, Bhati R: The use of an asynchronous learning network for senior house officers in emergency medicine. Emerg Med J 2007, 24(6):427–428. 17. Monaco M, Martin M: The Millenial Student: A New Generation of Learners. Athl Train Educ J 2007, 2:42–46. 18. Napier NP, Dekhane S, Smith S: Transition to blended learning: understanding student and faculty perspectives. JAsync LearnNetwork 2011, 15(1):20–32. 19. Burnette K, Ramundo M, Stevenson M, Beeson MS: Evaluation of a Web- based asynchronous pediatric emergency medicine learning tool for residents and medical students. Acad Emerg Med 2009, 16(Suppl 2):46–50. 20. Sadosty AT, Goyal DG, Hern G, Kilian BJ, Beeson MS: Summary recommendations from the 2008 CORD academic assembly conference alternatives workgroup. Acad Emerg Med 2009, 16(Suppl 2):25–31. doi:10.1186/1472-6920-13-105 Cite this article as: Jordan et al.: Asynchronous vs didactic education: it’s too early to throw in the towel on tradition. BMC Medical Education 2013 13:105. 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Asynchronous vs didactic education: it’s too early to throw in the towel on tradition

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Copyright © 2013 by Jordan et al.; licensee BioMed Central Ltd.
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Education; Medical Education; Theory of Medicine/Bioethics
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Abstract

Background: Asynchronous, computer based instruction is cost effective, allows self-directed pacing and review, and addresses preferences of millennial learners. Current research suggests there is no significant difference in learning compared to traditional classroom instruction. Data are limited for novice learners in emergency medicine. The objective of this study was to compare asynchronous, computer-based instruction with traditional didactics for senior medical students during a week-long intensive course in acute care. We hypothesized both modalities would be equivalent. Methods: This was a prospective observational quasi-experimental study of 4th year medical students who were novice learners with minimal prior exposure to curricular elements. We assessed baseline knowledge with an objective pre-test. The curriculum was delivered in either traditional lecture format (shock, acute abdomen, dyspnea, field trauma) or via asynchronous, computer-based modules (chest pain, EKG interpretation, pain management, trauma). An interactive review covering all topics was followed by a post-test. Knowledge retention was measured after 10 weeks. Pre and post-test items were written by a panel of medical educators and validated with a reference group of learners. Mean scores were analyzed using dependent t-test and attitudes were assessed by a 5-point Likert scale. Results: 44 of 48 students completed the protocol. Students initially acquired more knowledge from didactic education as demonstrated by mean gain scores (didactic: 28.39% ± 18.06; asynchronous 9.93% ± 23.22). Mean difference between didactic and asynchronous = 18.45% with 95% CI [10.40 to 26.50]; p = 0.0001. Retention testing demonstrated similar knowledge attrition: mean gain scores −14.94% (didactic); -17.61% (asynchronous), which was not significantly different: 2.68% ± 20.85, 95% CI [−3.66 to 9.02], p = 0.399. The attitudinal survey revealed that 60.4% of students believed the asynchronous modules were educational and 95.8% enjoyed the flexibility of the method. 39.6% of students preferred asynchronous education for required didactics; 37.5% were neutral; 23% preferred traditional lectures. Conclusions: Asynchronous, computer-based instruction was not equivalent to traditional didactics for novice learners of acute care topics. Interactive, standard didactic education was valuable. Retention rates were similar between instructional methods. Students had mixed attitudes toward asynchronous learning but enjoyed the flexibility. We urge caution in trading in traditional didactic lectures in favor of asynchronous education for novice learners in acute care. Keywords: Medical student education, Emergency medicine, Computer based education, Asynchronous learning * Correspondence: [email protected] Department of Emergency Medicine, Harbor-UCLA Medical Center, 1000 W. Carson St., Box 21, Torrance 90509-2910, CA, USA David Geffen School of Medicine at University of California, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA Full list of author information is available at the end of the article © 2013 Jordan et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Jordan et al. BMC Medical Education 2013, 13:105 Page 2 of 8 http://www.biomedcentral.com/1472-6920/13/105 Background ACC are required to participate in an intensive, weeklong Methods of education continually evolve to meet the educational experience at the beginning of the fourth year. ever-changing needs of instructors and learners. Asyn- This course consists of didactic lectures, small-group chronous, computer-based instruction has become more interactive activities, procedural training on unembalmed prevalent in recent years. Asynchronous learning is a cadavers, full-scale human simulation of critical patient student centered instructional method where interac- management scenarios, and career development sessions. tions between teachers and learners occur independent Students in previous years have asked repeatedly for more of place and time [1]. This type of learning holds the po- hands-on time in the simulation, cadaver, and procedural tential for increased cost-effectiveness, greater flexibility, labs, but educators have struggled to increase this compo- self-directed pacing and review, and improved efficien- nent without compromising time spent on the acute care cy of educator resources [2,3]. These potential benefits core content that is essential to the students’ knowledge particularly apply to medical education where new dis- base to prepare them for both the interactive sessions and coveries are made daily, placing increasing demands on eventual patient management. In prior years, this standard educators and students to share knowledge despite in- curriculum was delivered in classroom lecture format at creased regulations of duty hours and costs. In post- the beginning of each day of the course. To address the graduate training programs, the prospect of including desire to expand the smaller group formats, we offered asynchronous learning modules to meet the conference asynchronous, computer-based instruction to deliver half attendance requirements set forth by the Accreditation of the core course content to our novice learners, thus Council for Graduate Medical Education (ACGME) [4] freeing up more time for hands-on and small group expe- is highly desirable. Additionally, in 2008, a report issued riences. We hypothesized that there would be no signifi- by the Macy Foundation highlighted the need for indi- cant difference between the two instructional methods. vidual practitioners to monitor and address their own The objectives of our study were to: (1) assess if senior learning to keep up with changes in medical practice [5]. medical students improve their medical knowledge with Asynchronous education can provide this opportunity, asynchronous, computer-based instruction and traditional thus has large appeal in the medical profession. didactic lectures to the same level during a one-week re- Most research surrounding computer based learning quired course in acute care; and (2) explore students’ atti- to date suggest that there is no significant difference be- tudes towards asynchronous and didactic instruction. tween traditional classroom-based and asynchronous, computer-based instruction. Randomized controlled tri- Methods als looking at the effectiveness of an asynchronous, com- Study setting and participants puter based course versus traditional classroom teaching All fourth-year medical students enrolled in the 2011–2012 of evidence based medicine found that computer-based ACC Foundations Course at the David Geffen School of learning was as effective at increasing a student’s know- Medicine at UCLA participated. This study was certified ledge as traditional classroom teaching [6,7]. A 2008 as exempt by the Institutional Review Board from the meta-analysis regarding internet based learning in the David Geffen School of Medicine at UCLA Office for health professions utilizing data from 76 studies con- Protection of Human Subjects. cluded that there was no significant difference in effect- iveness between traditional and internet based methods [8]. Other studies have been performed in infection con- Study design trol [9], neuroanatomy [10], and respiratory medicine This was a prospective, observational, quasi-experimental [11], which showed a similar effect between classroom curricular evaluation study. Pre- and post-test items were and asynchronous, computer-based instruction. There developed and revised by the authors (all were course are limited data on this comparison in acute care or faculty). Post-test questions differed from the pre-test emergency medicine (EM); however, a few studies questions to minimize recollection bias, but covered the looking at the instruction of emergency procedures via same topics. Items were randomly assigned, by our non- an online asynchronous format have yielded positive physician study coordinator, to be on either the pre- or results [12,13]. post-test. Both knowledge tests were carefully blue- At the David Geffen School of Medicine at the University printed to ensure each form contained an equal number of California, Los Angeles, fourth year students self-select of items of critical topics from each module, ensuring and enroll in one of five colleges based on their future car- content validity. Pre- and post-tests were found to be of eer choice or interest in the unique curricular offerings of comparable difficulty by utilizing a separate group of an individual college. The Acute Care College (ACC) is reference learners, emergency medicine interns, whose typically comprised of students who plan to specialize in mean pre-test score was 55.83% ± 15.51 and mean post- Anesthesiology, EM, or Critical Care. Students of the test score was 58.33% ± 11.68. This difference was not Jordan et al. BMC Medical Education 2013, 13:105 Page 3 of 8 http://www.biomedcentral.com/1472-6920/13/105 significant with a mean difference of −2.5% [−17.67 to computer-based modules (chest pain, EKG interpretation, 12.67]; p = 0.76. pain management, field trauma). Selection of mode of Further in depth analysis of the reference group found teaching was based on the desire to vary content and to that there was not a significant difference in perform- accommodate professor availability. To the best of our ance on pre-test questions covering asynchronous con- knowledge there was nothing inherent in the topics that tent and pre-test questions covering didactic content would make them more amenable to either method of de- with mean scores of 60.72% ± 19.84 and 53.13% ± 12.94 livery. The professors conducting the real-time sessions respectively with a mean difference of 7.60% [−5.07 to were the usual lecturers for the course and welcomed 20.25]; p = 0.20. There was also not a significant differ- audience participation. All had earned excellent to out- ence in performance of the reference group on post-test standing evaluations by students in prior years. Each lec- questions covering asynchronous and didactic content ture was 45 minutes in duration and was scheduled as the with mean scores of 65.63 ±17.36 and 48.21 ± 15.15 re- first activity of the morning. spectively with a mean difference of 17.41% [−0.66 to The asynchronous, computer-based modules consisted 35.48]; p = 0.57. Lastly the reference group did not show of two digitally recorded podcast lectures (chest pain a significant difference in performance between pre- and and acute pain management) by the same faculty who post-test questions covering asynchronous content gave them annually as “live” sessions in previous years (mean scores of 60.72 ± 19.84 and 65.63 ± 17.40 respect- and who were also highly rated by prior students. These ively, mean difference of 4.91% [−26.54 to 16.72]; p = lectures were assigned to this modality based on faculty 0.61) or didactic content (mean score of 53.13 ± 12.94 willingness to convert their usual lecture to an asyn- and 48.21 ± 15.15 respectively, mean difference of −4.91% chronous format. Both specifically highlighted concerns [−12.53 to 22.35]; p = 0.53). This comprehensive analysis that had been raised consistently by students in prior suggests that pre- and post-tests were of similar difficulty years. The third module (field trauma) was a video of for both asynchronous and didactic content. trauma cases and debriefings that was shown in previous Figure 1 depicts the flow of our study. On Day 1, each years as the didactic session, in which the creating professor participant provided demographic data (age, gender, and was present to answer questions and assure compliance. intended specialty), followed by a knowledge pre-test The final asynchronous module (EKG interpretation) was comprised of multiple choice single answer questions prepared specifically for asynchronous education. It con- about the core didactic topics (shock, acute abdomen, sisted of examples of EKGs with detailed analysis and ex- dyspnea, trauma, chest pain, EKG interpretation, and planations. This was similar to the format used when this pain management). topic had been delivered in the large group format. The standard curriculum on these topics was delivered All four asynchronous, computer-based modules were in either traditional classroom lecture format (shock, acute uploaded to the university’s educational website which abdomen, dyspnea, ED trauma) or via asynchronous, is familiar to all students. The website can be accessed DAY 1 Demographic Questionnaire and Cognitive Pre-Test DAY 2-5 DAY 2-5 Core Topics: Didactic Lectures Core Topics: Asynchronous Learning Shock, Acute Abdomen, Field Trauma, Dyspnea Chest Pain, EKGs, Pain, ED Trauma DAY 5 Interactive Group Review: Question-Answer Format DAY 5 Cognitive Post-Test and Attitudinal Survey DAY 70 Cognitive Retention Post-Test Figure 1 Study flowchart. Jordan et al. BMC Medical Education 2013, 13:105 Page 4 of 8 http://www.biomedcentral.com/1472-6920/13/105 Table 1 Student demographics remotely, allowing students to view the modules on their own time in the location of their choosing, including Total n = 44 their own personal or home computers. Additionally, Mean age (years) 25.8 students were allocated one daily block of unscheduled Female 16 time during the week where they had no structured ac- Male 28 tivities and could choose to use the time to complete the Intended specialty: asynchronous modules, ask for clarification from course Critical care 22 faculty, meet with mentors, or tend to personal matters. The medical school’s computer learning laboratory was Emergency medicine 15 reserved for their use throughout the course, and they Anesthesia 7 were also entitled to use university computers after Results reported as n or years. hours. The length of time spent on the asynchronous, computer-based modules was self-directed and unlim- Mean gain scores (relative to post scores) were −14.94% ited, and students had the option to go back and review (didactic); -17.61% (asynchronous). This was not signifi- the material at any time. While students were allowed to cantly different, with a mean difference of 2.67% ± 20.85, perform asynchronous learning in teams, each had to 95% CI [−3.66 to 9.02], p = 0.399. Mean scores for the re- log on to document enrollment in each module to re- tention test in the asynchronous group were lower than ceive course credit. pre-test scores, 51.99% ± 13.46 and 62% ±15.69 respect- On the final day (Day 5), faculty conducted a 1-hour ively. This difference was statistically significant with group interactive, question-answer review session equally amean difference of −10.02% ± 15.48, 95% CI [−14.73 covering both asynchronous and traditional topics. The to −5.32]; p = 0. Mean gain scores are depicted in Table 2. purpose of this review was to ensure that everyone had an Mean scores for pre, post, and retention testing are opportunity to clarify concepts and fill in gaps in know- depicted in Table 3. There was a significant difference in ledge on all subject matter. At the end of Day 5, students pre-test scores for asynchronous and didactic groups with took a multiple choice post-test to assess their knowledge mean scores of 62% ± 15.69 and 39.75% ± 13.29 respect- gain and completed a five-point Likert scale questionnaire ively with mean difference of 22.24% ± 22.06, 95% CI to assess attitudes toward asynchronous and didactic in- [15.53 to 28.95]; p = 0. struction. Ten weeks later, students again completed the Students had mixed attitudes towards asynchronous multiple choice post-test to assess knowledge retention, education (Figure 2). Students uniformly (95.8%) enjoyed during a regularly scheduled educational meeting. the flexibility afforded by asynchronous learning however, only 60.4% believed the asynchronous modules were edu- Data analysis cational. When asked which type of learning they pre- We calculated the percentage of correctly answered ferred, 39.6% indicated that asynchronous education was questions for each instructional method and computed a preferable for required didactics, 37.5% were neutral, and gain score by subtracting pre-test scores from post-test 23% preferred traditional lectures. scores. We compared instruction methods using a dependent t-test of mean gain scores. Data were ana- Discussion lyzed with IBM SPSS version 20 (IBM Software group, The results of this study suggest that asynchronous, Chicago, IL). computer-based instruction is not equivalent to didactic instruction of an acute care curriculum for novice Results learners. In a rapidly changing educational climate where All 48 students enrolled in the course consented to par- increasing constraints are placed on funding and time, ticipate in the study. 44 of 48 completed the study asynchronous, computer based instruction seems like an protocol. Four were absent during the administration of exciting alternative; however, like any new method, it the 10-week retention test and so their data were not in- Table 2 Mean gain scores cluded in the analysis. Demographic characteristics are displayed in Table 1. Pre test to post Post test to retention test % ± SD test % ± SD Mean gain in knowledge was 28.39% ± 18.06 for didactic Didactic 28.39 ± 18.06 −14.94 ± 18.73 instruction and 9.93% ± 23.22 for asynchronous instruc- tion. A two-tailed dependent t-test revealed a statistically Asynchronous 9.93 ± 23.22 −17.61 ± 17.12 significant mean difference between didactic and asyn- Mean difference% ± SD 18.45 ± 27.72 2.68 ± 20.85 chronous modalities of 18.46% with 95% CI [10.40 to 95% CI [10.40 to 26.50] [−3.66 to 9.02] 26.50]; p = 0.0001. Retention testing after 10 weeks dem- p value p = 0.0001 p = 0.399 onstrated similar knowledge attrition for both groups. Jordan et al. BMC Medical Education 2013, 13:105 Page 5 of 8 http://www.biomedcentral.com/1472-6920/13/105 Table 3 Mean test scores Our results contrast with much of the current litera- Pre test Post test Retention test ture that generally has found that asynchronous and di- %±SD %± SD %±SD dactic education are equivalent. We hypothesize that Didactic 39.75 ± 13.29 67.86 ± 11.99 52.92 ± 18.89 there are several factors that may account for this. First, students had a higher baseline knowledge of the asyn- Asynchronous 62 ± 15.69 69.63 ± 15.10 51.99 ± 13.46 chronous topics, as evidenced by a higher mean pre-test score. This finding was not demonstrated in the refer- lacks a thorough evidence based assessment. Asynchron- ence group. Therefore, the lack of gain seen with this ous learning requires a substantial investment of re- method may have been due partially to a ceiling effect. sources initially for product design, implementation, and This higher baseline knowledge may be due to prior monitoring, but offers long term benefits of saving in- education, though these students had received only min- structor time and reducing logistical planning for class- imal exposure to the studied content. Larger, multi- room space in subsequent years. Additionally, student institution studies may elucidate whether this finding is learning may be facilitated by allowing students to learn consistent. at a time, place, and setting convenient for them. Asyn- Additionally, while didactic education is considered to chronous learning can also free up time in a curriculum be a one-way transmission of material from teacher to for more hands on learning of topics that must be conducted learner, we cannot overlook the possibility of meaningful in a face-to-face manner. Despite these stated benefits, interaction between experts and learners during live lec- asynchronous learning may not be worth the investment if tures. This type of interaction, which allows for immedi- we do not find at least equivalency with current teaching ate clarification of concepts and extension of knowledge, methods. It is prudent to be wary of investing in a pro- may be particularly important for novice learners who gram that has not been fully evaluated. have relatively little exposure to the subject matter, such "I Found the Asynchronous Modules to be Educational." "I Enjoyed the Flexibility of the Asynchronous 18 Modules." 1 = Strongly Disagree 3 = Neutral 5 = Strongly Agree 1 = Strongly Disagree 3 = Neutral 5 = Strongly Agree Likert Scale Likert Scale "I Prefer a Traditional Didactic Lecture for Required "I Prefer Asynchronous Education for Required Topics." Topics." 0 0 12345 12345 1 = Strongly Disagree 3 = Neutral 5 = Strongly Agree 1= Strongly Disagree 3 = neutral 5 = Strongly Agree Likert Scale Likert Scale Figure 2 Results of attitudinal survey. Number of Responses Number of Responses Number of Responses Number of Response Jordan et al. BMC Medical Education 2013, 13:105 Page 6 of 8 http://www.biomedcentral.com/1472-6920/13/105 as our study population. Most rigorous studies on design that would require the learner to demonstrate under- factors for asynchronous “distance learning” education standing of information before moving on to the next can be found in the literature describing undergraduate step. Ready access to others on a discussion board might (college) education, and have emphasized the import- serve a similar purpose. ance of interaction amongst the peer learners and be- Students’ attitudes may also have contributed to our tween the instructors and students, that focuses on results. No educational method can succeed without a course content and learning issues. This “community of critical amount of learner “buy-in” and, as demonstrated inquiry” has a profound impact on learning outcomes by our attitudinal assessment, this study population, and satisfaction [14,15]. Increased interaction within while generally favorable, had mixed opinions regarding asynchronous modules, amongst peers and between asynchronous compared to didactic instruction. Current learners and instructors via a discussion board may yield literature on this topic does not always include learner more positive results for asynchronous learning, as it did attitudes towards various methods and whether they cor- in a study of EM house officers [16]. In our model, we relate with outcomes. To ensure success of asynchronous believed that we had provided students with the oppor- instruction, curriculum developers must identify why stu- tunity to seek feedback and ask questions by carving out dents may not have positive attitudes towards this modal- a designated time during their individual schedules for ity and create solutions to address these barriers. each day. In past years, we noted that some students felt Asynchronous learning may be a tool that is better frustrated by the rapid pace of traditional didactic learn- used as a complement to traditional education rather ing without an opportunity to clarify points individually. than a replacement, especially in the setting of EM. Some complained that the lectures had moved forward Blended learning that combines interactive didactics too quickly and that they wished they could have re- with asynchronous modules may be a successful method, peated the basics before attempting the more difficult capitalizing on the strengths of both techniques and material. Others indicated a need for unscheduled time minimizing the weaknesses [18]. The few studies in the during the business day to attend to matters such as field of EM support more of a blended model rather mentor meetings and personal issues. than favoring one or the other [19,20]. Many studies on asynchronous instruction in medical Lastly, though our study suggests that asynchronous education and healthcare focused on a single topic and didactic education may not be equivalent for know- [7,9-11,13]. Our study, while aimed at a single learner ledge acquisition, we did see similar knowledge attrition group, sought to impart information across a diverse after a period of time in both groups so that we cannot range of topics in acute care. We believe that the re- favor one method over the other in terms of retention of quired use of an interactive supplement to the independ- knowledge. Interestingly, mean retention scores for the ent learning modules in the form of specific face-to-face asynchronous group were lower than mean pre-test encounters or mandatory online teacher-moderated dis- scores. We did not find a significant difference between cussion boards would mitigate the difficulties inherent test items in our reference group. On the surface, it in mastering new information. Successful university pro- seems counterintuitive that students would lose more grams cited this as a key element when their asynchron- knowledge than they started out with. We postulate that ous learning course had a broad focus [14,15]. It is likely students may have faced some degree of “information that frequent knowledge checks and student account- overload” given the intense knowledge acquisition across ability would create a positive learning condition, and several different topics in a relatively short time frame. could provide an avenue for clarification that might Additionally, students who were complete novices may otherwise seem daunting for a novice learner. have been able to answer the questions from a simpler Our results may also indicate a mismatch between edu- perspective. As they acquired more knowledge during their clinical encounters and extended their experience, cational methods and learner needs. While asynchronous instruction does appeal to today’s millennial learner’spref- the objective test items may have evoked a more compli- erence for flexibility, use of technology, and audio-visual cated thought process that extended beyond the straight- forward answers that were more obvious when the stimulation, it also places a significant amount of responsi- bility and need for independent monitoring on the learner. subject material represented the majority of their under- This self-directed approach may be more difficult for the standing at the beginning of the academic year. Improv- ing knowledge retention through various instructional millennial learner who typically has had a high level of parental and teacher involvement. These learners thrive methods is another area that warrants further research. on immediate delivery of knowledge and formative feed- back to maintain focus and enhance learning [17]. In Limitations and future directions modules such as those in our course, this could come in This study took place at one institution, so the results the form of frequent formative quizzes and “hard stops” may be difficult to generalize. It is particularly difficult Jordan et al. BMC Medical Education 2013, 13:105 Page 7 of 8 http://www.biomedcentral.com/1472-6920/13/105 to perform a randomized, controlled study in the educa- Competing interests The authors declare that they have no competing interests. tional setting. Because this was a required course, we felt it would be unethical to randomize students to different Authors’ contributions experiences. Additionally, it is possible that our inter- JJ is the principal investigator for this study and participated in study design, served as core faculty, wrote test items, and drafted the manuscript. AJ is active review on Day 5 could have accounted for the lack responsible for maintaining and analyzing data for the study. SC served as of difference between groups in the post-test. It may core faculty wrote test items, and contributed to the manuscript. PD served have been more telling if we had conducted the post-test as core faculty, wrote test items, and contributed to the manuscript. TS served as core faculty and contributed to the manuscript. WC supervised all prior to this session. It is also important to note that the aspects of the study and edited the manuscript. All authors read and term “asynchronous” applies to an enormous variety of approved the final manuscript. educational modalities - from podcasts to interactive Authors’ information games. We urge caution in generalizing our results to all JJ is a fellow in Medical Education at Harbor-UCLA Department of formats of asynchronous instruction. Our curriculum in- Emergency Medicine and Director of Asynchronous Learning for the Acute cluded a variety of teaching modalities. It is likely that Care College at UCLA School of Medicine. AJ is a research associate and the coordinator for the Acute Care College at UCLA School of Medicine. SC is each student could find something appealing in this mix, assistant professor of Emergency Medicine at University of California, Davis. however, the superiority of any one modality could not During this project, he was a Medical Education fellow at Harbor-UCLA be determined with this approach. We felt such a varied Emergency Medicine and Director of Simulation Education for the Acute Care College at UCLA. PD is Professor of Medicine at UCLA School of curriculum was more representative of our existing Medicine and Director of Preclinical Education for the Acute Care College. TS course and chose to evaluate it as a whole. is Assistant Professor of Medicine at UCLA School of Medicine and Director Despite these limitations, our study does provide signifi- of Continuing Education for the Acute Care College. WC is a Professor of Medicine and Chair of the Acute Care College at UCLA School of Medicine; cant results that should encourage the medical education Director of Medical Education, and Director of the Fellowship in Medical community to further examine the merits of traditional Education at Harbor-UCLA Department of Emergency Medicine. lectures and asynchronous educational methods. We urge educators to select the appropriate method based on their Acknowledgements The study was supported by Acute Care College funds from the Office of the learners’ needs. Asynchronous, computer-based instruc- Dean and the Department of Educational Development and Research at the tion still has the potential for significant value as a cur- David Geffen School of Medicine at the University of California, Los Angeles. ricular component. However, we caution against “jumping Presentations on the asynchronous band-wagon” and closing the door on traditional methods that have withstood the test of 1. Oral Research Presentation at the Plenary Session of the Academic time. There are still many questions left unanswered. Assembly: Council of Residency Directors (CORD), April 2012, Atlanta, GA; More research is required, perhaps beginning with a quali- 2. Oral Research Presentation at the Society: Academic Emergency tative exploration, to define the value and application of Medicine (SAEM) Western Regional Forum, March 2012, Las Vegas, NV; asynchronous education in the setting of EM and acute 3. Moderated poster: SAEM Annual Meeting, May 2012, Chicago, IL. care, particularly when the learners are novices. Proper Author details attention in selecting effective asynchronous topics, me- Department of Emergency Medicine, Harbor-UCLA Medical Center, 1000 W. thods, and targeting appropriate learner groups should be Carson St., Box 21, Torrance 90509-2910, CA, USA. David Geffen School of Medicine at University of California, 10833 Le Conte Avenue, Los Angeles, CA further elucidated. 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BMC Medical Education – Springer Journals

Published: Aug 8, 2013

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