The efficacy of blended learning in a pediatric spinal deformity management program in Tanzania

ABSTRACT

Introduction: Blended learning, which combines in-person learning and e-learning, has grown rapidly in education. Advantages of this modality include control over content, learning sequence, and pace of learning, allowing participants to tailor their experiences to meet their personal learning objectives. Blended learning enables adaptive and collaborative learning and transforms the teacher's role from transmitting knowledge (instructing) to facilitating learning. Objectives: Our study aimed to assess the efficacy of blended learning in a pediatric scoliosis training program through the largest Surgical Training Institution in Sub-Saharan Africa, The College of Surgeons of East, Central and Southern Africa (COSECSA). Material and Methods: The course comprised of three parts;1-the online portion, which allowed participants to review lectures, papers, and audiovisual materials over a 3-week period;2-the in-person session, where participants spent a full day with an international expert, reviewing cases in a team-based approach and coming to a consensus on treatment strategy;and 3-a one week, in-person experience where participants were exposed to pre-surgical planning conferences, clinic, casting, and scrubbing into surgeries with international experts. All participants completed a Needs Assessment (NA) and quiz prior to the course. The NA contained 6 various topics, with 3 questions for each topic scored by a 10-point scale in pediatric spine deformity. The quiz included 15 surgical and clinical questions related to the pediatric spine deformity topics. The NA and quiz were taken before the course, after the online session, and after the in-person session. A final survey was conducted at the end of the in-person surgical week. Results: Thirty-six orthopedic surgeons and neurosurgeons enrolled in the course primarily from Tanzania, Kenya, and Malawi. The NA assessment scores improved significantly over the course of the three surveys from 67.3 prior to the course, to 90.9 mid-course, and 94.0 after the course (p = 0.0007). The clinical quiz scores improved over the 3 time points from 9.91 to 11.9, and 12.3, respectively. At the end of the in-person surgical week, 100% of respondents stated that they had improvement in knowledge and 92% considered the knowledge sufficient to change their clinical practice. In surveying the persistent obstacles to translating knowledge gained through blended learning to clinical practice, the top responses were constraints in personnel and cost of implants at their home institution. Conclusion: The blended learning approach in a pediatric spine deformity program is effective, feasible, and shows a statistically significant change in participants' confidence and knowledgebase in these complex pathologies. Our results are limited due to the small sample size. Future studies will evaluate larger number of participants in the post-COVID era and translation to other areas of spine surgery, such as minimally-invasive surgery.