Educational Problems Clinical Trial
Official title:
Test-enhanced Learning Using Causal Connections to Prepare for Future Learning in Endocrinology: a Randomized Clinical Trial
The use of test-enhanced learning with causal connection and in preparation for future
learning has been used in health educational setting with positive results. However, most
studies were performed in a controlled lab scenario and not in the "real world" of medicine
classes, decreasing the external applicability of such experiments. Therefore, the aim of
present study is to evaluate if a session of test-enhanced learning at the beginning of
endocrinology course, using basic-clinical sciences connections of key concepts, would
prepare for future learning of endocrinology on a theory-practical 4-week endocrinology
course.
Methods Study design, participants and description of undergraduate endocrinology course This
is a prospective, single center, non-blinded, RCT. Participants are students of medicine from
Universidade Federal do Rio Grande do Sul (UFRGS), Brazil, in their third year of Medical
School, recruited at the beginning of endocrinology undergraduate clinical placement. This
clinical trial follows the Consolidated Standards of Reporting Trials (CONSORT) statement,
which includes the completing the CONSORT checklist.
Sample size Based in a previous study, to find a difference in the percentage of correct
answers in a cognitive test to evaluate retention of 12%, considering a SD of 26%, alpha
error of 5%, beta error of 20%, and repeated assessments (baseline, 3 weeks and 6 months), 35
students will be necessary in each group. To account for possible losses of follow-up, 84
students will be included.
Study intervention All students will receive, in advance, a text with basic sciences
information relevant to the learning of Endocrinology (supplementary material), with
instructions to study the text before intervention day.
Students will be randomized to one of the interventions: TEL with questions about diabetes
and adrenal (Block A, 6 questions) or thyroid and hypophysis (Block B, 6 questions).
Important endocrinology concepts, such as fuel metabolism and circadian rhythm will be
included in Block A, and feedback loops and hormone synthesis in Block B. Specific hormone
functions will be part of both TEL Blocks.
Assessments At the same day of intervention, students will answer all questions 12 of the TEL
session (questions from blocks A and B) with best answer multiple choice questions (immediate
retention test). After 3 weeks and 6 months, the transfer of knowledge will be assessed with
a 24 multiple choice questions test, based in clinical cases.
Introduction The ability to connect previous learned basic-sciences concepts to patient's
clinical features can help improve clinical reasoning. While experts use several shortcuts to
reach a correct diagnosis, such as clinical presentation patterns, "stored" due to years of
exposure to real cases, the novice need other strategies to build diagnostic scripts to
achieve expertise. Inexperienced medical students acquire clinical reasoning by exploring why
specific symptoms occur, usually based on basic science mechanisms. Even experienced
physicians apply these connections to solve difficult cases, though sometimes, not in a
conscious way. Benefits of causal connections between basic and clinical sciences for
clinical reasoning is supported by randomized clinical trials (RCTs). When teaching
endocrinology, this strategy acquires additional relevance, as basic concepts regarding
hormone action and regulation (ex: feedback loops) are commonly utilized in day-to-day
patient care.
Test-enhanced learning is an effective strategy to optimize knowledge acquisition, through
formative assessment with the sole objective to promote learning. Testing improves learning
through two means: a) an indirect benefit, as it stimulates preparation for the test, and b)
through a direct effect, in which the mental effort to answer a question mobilizes and brain
connections and reinforces learning. This educational tool has been studied in health
professions education, including medical school and clinical training. The utilization of
test-enhanced learning with short answers is more efficacious than only restudy or
self-explanation. Moreover, the effect lasted for at least 6 months.
More important than content retention and linkage between biomedical concepts and clinical
features, is the idea that knowledge must be applied in a different context in the future, a
capacity named adaptive expertise. An essential part of training for adaptive expertise is
preparation for future learning. It means that a learning session should prepare the student
for future acquisition of content, competences and abilities. Medicine is certainly an area
where adaptive expertise is crucial, as biological sciences are in continuous progress,
requiring constant and continued education.
The use of test-enhanced learning with causal connection and in preparation for future
learning has been used in health educational setting with positive results. However, most
studies were performed in a controlled lab scenario and not in the "real world" of medicine
classes, decreasing the external applicability of such experiments. Therefore, the aim of
this study is to evaluate if a session of test-enhanced learning at the beginning of
endocrinology course, using basic-clinical sciences connections of key concepts, would
prepare for future learning of endocrinology on a theory-practical 4-week endocrinology
course.
Methods Study design, participants and description of undergraduate endocrinology course This
is a prospective, single center, non-blinded, RCT. Participants are students of medicine from
Universidade Federal do Rio Grande do Sul (UFRGS), Brazil, in their third year of Medical
School, recruited at the beginning of endocrinology undergraduate clinical placement. This
clinical trial follows the Consolidated Standards of Reporting Trials (CONSORT) statement,
which includes the completing the CONSORT checklist.
Sample size Based in a previous study, to find a difference in the percentage of correct
answers in a cognitive test to evaluate retention of 12%, considering a SD of 26%, alpha
error of 5%, beta error of 20%, and repeated assessments (baseline, 3 weeks and 6 months), 35
students will be necessary in each group. To account for possible losses of follow-up, 84
students will be included.
Study intervention All students will receive, in advance, a text with basic sciences
information relevant to the learning of Endocrinology (supplementary material), with
instructions to study the text before intervention day.
Students will be randomized to one of the interventions: TEL with questions about diabetes
and adrenal (Block A, 6 questions) or thyroid and hypophysis (Block B, 6 questions).
Important endocrinology concepts, such as fuel metabolism and circadian rhythm will be
included in Block A, and feedback loops and hormone synthesis in Block B. Specific hormone
functions will be part of both TEL Blocks.
Assessments At the same day of intervention, students will answer all questions 12 of the TEL
session (questions from blocks A and B) with best answer multiple choice questions (immediate
retention test). After 3 weeks and 6 months, the transfer of knowledge will be assessed with
a 24 multiple choice questions test, based in clinical cases.
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