Computer-Assisted Learning Helps Teach Epistaxis Management

PHOENIX-Medical students who use computer-assisted learning (CAL) when learning epistaxis management have superior performance over their counterparts who simply go by the book. At least this is the finding from a randomized trial of first-year medical students who studied nasal packing techniques either by CAL, or via a standard textbook chapter on the topic. Details of the study were presented at the Triological Society section at the recent annual Combined Otolaryngology Spring Meeting by Jordan Glicksman, BSc, a third-year medical student at the Schulich School of Medicine and Dentistry at the University of Western Ontario in London, Ontario.

Computer-assisted learning has been increasing in medical education. It has many advantages, such as allowing students to learn at their own pace, and at the time and location of their choosing, he said. In addition, there are great multimedia capabilities: As well as containing reading and quizzes, in some programs students can practice techniques in a virtual, 3D format and get feedback. It is also a helpful teaching aid for use in rural settings, at satellite campuses, and in developing countries, he said.

Barriers to wider use of CAL include the extra cost of the learning modules, and conflicting evidence in the medical literature about their effectiveness as a learning tool.

However, in some places, such as Canada, there has been a shift toward more self-directed learning in medical education. Indeed, its use is becoming more widespread: In 2003 there were 11,000 online courses available, and that number has increased by more than 10 times now, he said. Self-directed learning can help students identify their own deficiencies and gives them the ability to pursue information and activities to fill in the gaps.

We feel that CAL is an excellent way of orienting students through these interactive activities and quizzes, and we feel that this could potentially allow students a better educational experience, Mr. Glicksman said. At the same time, CAL will not replace other forms of continuing education, and doctors will still need to do things such as attending conferences and reading journal articles.

CAL in Otolaryngology

But just how useful is CAL in otolaryngology? This is an area that has been poorly studied, especially with respect to its effectiveness in teaching procedural skills and in epistaxis management. The lack of evidence is what motivated the launch of this study, he said.

A prospective, blinded, randomized control trial was performed in which first-year medical students were randomized into one of two teaching groups. The first group of 23 students received a teaching module to use on their computer, whereas the second group, comprising 24 students, were given text-based instructions printed on paper. The text-based article was based on a peer-reviewed journal article.

The CAL module content was based entirely on the same article, but had interactive components such as quizzes and exercises. Its content was designed to be identical to that of the article provided to the students. The video included text as well as audio/video to describe the relevant procedures, Mr. Glicksman said. He noted that development of the module was a team effort.

Students were also provided with a plastic model of a nose to pack by one of two methods: either a formal nasal pack, or a tampon pack. Students were evaluated on proper nasal packing technique, using both standardized subjective and objective outcome measures, by three board-certified otolaryngologists.

Objective measurements were taken using a global rating system, which included how long it took to perform the procedure, respect for tissue, instrument handling, flow of operation, knowledge of procedure, overall performance, and quality of the final product. For tampon placement, the students were graded as either correct or incorrect for use of a headlamp, forceps, placement of the tampon, and moistening of the gauze afterward. Blinded assessments of the students and their nasal packing skills were performed prior to instruction from their assigned method, as well as after they completed their study. They were also videotaped while they did the nasal packing.

CAL Leads to Greater Improvements than Text Alone

Not surprisingly, both groups of students performed poorly before studying nasal packing techniques. After the text-based learning there were definite improvements, but when you compare it to the CAL group, the CAL group did much better, Mr. Glicksman said. The difference between the two groups was, overall, statistically significant.

Students who studied the formal packing technique via CAL packed the model nose faster with the gauze and were able to insert larger amounts of gauze than the students who studied via the text-based approach.

As for the time to pack the model nose, the computer-based group took an average of 125.3 seconds, compared with the text-based group’s average of 155.6 seconds, after completing the study units. The computer-based group packed an average of 178.3 cm of gauze, compared with 134.6 cm by the text-based group, a difference that was statistically significant. With tampon insertion for epistaxis, the computer-based group took an average of 75.4 seconds, compared with 62.3 seconds by the text-based group, but here the difference was not statistically significant.

Afterward, students were asked which method they would prefer to learn by. A total of 94 percent of students said they prefer the CAL module. It should be noted that out of the 47 participants, only one said that they would prefer the text article and two were indifferent, Mr. Glicksman said.

I think that our results show support for CAL in teaching students procedural skills. We hope that this can set a precedent for more of these types of modules to be produced in the future, he said.

The module can be found online at http://uwoent.ca/files/epistaxismanagementhowtopackanose/player.html .

©2009 The Triological Society