If we extrapolate this result, it is likely that using an e-textbook and a reverse classroom can increase the usefulness of a teaching session, thereby allowing students to achieve more in a set time. This result showed that the intervention group required less direct teaching time to achieve the same level of competence as the control group. Hence, more of the teaching session could be focused on perfecting techniques and improving performance. Although this is a crude measure, it demonstrates that participants in the intervention group could learn at home before they entered the classroom. They did, however, require much less time before they could tie their first knot. Participants in the intervention group performed better than those in the control group at knot-tying immediately after the teaching session, though not significantly so. The intervention group continued to be able to use the e-textbook. All participants were encouraged to practise knot-tying between the two assessments but further instruction from a tutor was not provided. Participants were then video-recorded tying a knot under examination conditions (no input from the experimenter or reference to teaching materials was allowed).Īll study participants returned one week after the teaching session for repeat assessment of knot-tying, using the same protocol as the first assessment. Instruction and practice at knot-tying continued until the study participants reported that they felt confident with tying the knot and were ready to be assessed, or if 30 minutes had elapsed – whichever came first. Participants practiced knot-tying using a Knot-tying Trainer (Limbs & Things, Bristol, UK). The video and photographic illustrations contained in the e-textbook were used as learning resources for the intervention and control groups during the teaching sessions. Each teaching session was conducted in the same manner by the same experimenter (T Pike) using identical materials for all study participants.
The teaching session was conducted on a one-to-one basis with a study participant and an experimenter. Second, the teaching received by the control group was thought to be representative of ‘normal’ teaching practices, particularly at the undergraduate level. Therefore, the control group was not given any form of instruction before its face-to-face teaching session. First, we wanted to ascertain what effect (if any) delivering educational content through a reverse-classroom method had on the performance of basic surgical skills. This asymmetrical study protocol was employed for two reasons. Participants assigned to the control group were not provided with any material or instructions before their teaching session.
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The intervention group was asked to download Surgical Knots: A Guide from the iTunes Book Store and review it before their teaching session. Randomisation was concealed and achieved by assigning each participant a unique three-digit identification code. Study participants were randomised into control or intervention groups using a computer-generated random number sequence. By employing a novel pedagogy (the ‘reverse classroom’) and embracing technologically enhanced learning (an iPad™-based e-textbook), we hypothesised that current teaching modalities could be improved.
To try to increase the flexibility of learning and maximise the effectiveness of formal teaching sessions, we endeavoured to develop a better way of delivering educational content. 2– 5 These changes, mirrored by a reduction of residency hours in the USA, have reduced the number of hours that surgical trainees can spend in the operating theatre,6 where training traditionally took place.Ī recent review for the General Medical Council into the impact of the EWTD on medical education and training7 revealed that many trainees felt ‘they gained sufficient training experience within the current limit, although they were frustrated by a perceived lack of flexibility’ and that ‘pressure to deliver service means that more educational activity … takes place in the trainees’ own time’. This change has developed partly in response to restrictions of working hours enforced by the European Working Time Directive (EWTD),1 but also to address ethical, economic and legal concerns raised by historical education models. Simulation is being used increasingly as we move away from the old apprenticeship ‘see one, do one, teach one’ model. In recent years, surgical education at both undergraduate and postgraduate levels has changed.
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