vSEMERA: pilot project assessing health profession students' experiences in an international virtual research program.

BACKGROUND: The "Virtual Semester for Medical Research Aachen" (vSEMERA) is an international, interdisciplinary, virtual education program developed for health profession students. The first edition (2021) was hosted by the Medical Faculty of RWTH Aachen University (Germany) in cooperation with Centro Universitário Christus (Brazil) and Universidad Peruana Cayetano Heredia (Peru). The primary aim of the 12-weeks program was to provide students with skills in health science research and prepare them for scientific career paths. METHODS: vSEMERA was built on a virtual learning platform, the "vSEMERA-Campus", designed to foster students' learning process and social interactions. Maximum flexibility was offered through synchronous and asynchronous teaching, enabling participants to join via any device from any part of the Globe alongside their regular studies. For the program's first edition (September - November 2021), health profession students from Germany, Brazil, Peru, Spain, and Italy filled all 30 available spots. Satisfaction, quality of the program and courses offered, as well as perceived learning outcomes, were examined using questionnaires throughout and at the end of the program. RESULTS: The program received a rating of 4.38 out of 5 stars. While it met most expectations (4.29 out of 5), participants were unable to attend as many courses as intended (2.81 out of 5), mainly due to scheduling conflicts with the home university schedule (46%), internships (23%), and general timing issues (31%). Participants acknowledged considerable improvements in their scientific skills, English language skills, confidence in scientific project management, research career progression, and enthusiasm for a scientific career. CONCLUSIONS: vSEMERA represents a promising example of an online international learning and exchange program using pedagogical and technological elements of virtual collaboration and teaching. In addition to advancing future vSEMERA editions, our results may offer insights for similar projects that address the targeted integration of scientific research education into an international, digital learning environment.

Assessment and evaluation of a serious game for teaching factual knowledge in dental education.

OBJECTIVES: A serious game application was developed to train factual knowledge and for self-assessment. The aim of the present study was to compare the effects of a game application (intervention group) or paper scripts (control group) on knowledge acquisition and to evaluate the acceptance of the new application among dental students. METHODS: The 4th semester students of the second preclinical prosthodontics course were randomly assigned to one of the two groups (n = 58/51) for two consecutive years. The study was conducted in two phases: First, all participants took a pretest, with the intervention group using the game application and the control group receiving the same set of questions in a paper script. In the second phase, all participants took a post-test. After the post-test, both groups had access to the application for another three weeks. After that, all participants completed standardized questionnaires and a scale to evaluate the usability of the system. Usage statistics were also tracked. Differences between groups were evaluated together and for both years separately in terms of pretest and posttest scores and learning success. RESULTS: There was no significant difference between the groups with regard to the posttest and learning success. A significant improvement in knowledge between pretest and posttest (p < 0.05) was demonstrated in both groups. Each student played approximately 350 questions. Participants rated the application with the German school grade "good". Participants appreciated the application and rated it positively. They stated that the game motivated them to learn and that they spent more time with the learning content. CONCLUSION: Due to the positive perception achieved through the game, this application is able to motivate students to learn. The learning effect achieved is similar to learning on paper.

Effect of head-mounted displays on students' acquisition of surgical suturing techniques compared to an e-learning and tutor-led course: a randomized controlled trial.

BACKGROUND: Although surgical suturing is one of the most important basic skills, many medical school graduates do not acquire sufficient knowledge of it due to its lack of integration into the curriculum or a shortage of tutors. E-learning approaches attempt to address this issue but still rely on the involvement of tutors. Furthermore, the learning experience and visual-spatial ability appear to play a critical role in surgical skill acquisition. Virtual reality head-mounted displays (HMDs) could address this, but the benefits of immersive and stereoscopic learning of surgical suturing techniques are still unclear. MATERIAL AND METHODS: In this multi-arm randomized controlled trial, 150 novices participated. Three teaching modalities were compared: an e-learning course (monoscopic), an HMD-based course (stereoscopic, immersive), both self-directed and a tutor-led course with feedback. Suturing performance was recorded by video camera both before and after course participation (>26 h of video material) and assessed in a blinded fashion using the Objective Structured Assessment of Technical Skills (OSATS) Global Rating Score (GRS). Furthermore, the optical flow of the videos was determined using an algorithm. The number of sutures performed was counted, the visual-spatial ability was measured with the Mental Rotation Test (MRT), and courses were assessed with questionnaires. RESULTS: Students' self-assessment in the HMD-based course was comparable to that of the tutor-led course and significantly better than in the e-learning course ( P =0.003). Course suitability was rated best for the tutor-led course ( x̄ =4.8), followed by the HMD-based ( x̄ =3.6) and e-learning ( x̄ =2.5) courses. The median ΔGRS between courses was comparable ( P =0.15) at 12.4 (95% CI 10.0-12.7) for the e-learning course, 14.1 (95% CI 13.0-15.0) for the HMD-based course, and 12.7 (95% CI 10.3-14.2) for the tutor-led course. However, the ΔGRS was significantly correlated with the number of sutures performed during the training session ( P =0.002), but not with visual-spatial ability ( P =0.615). Optical flow ( R2 =0.15, P <0.001) and the number of sutures performed ( R2 =0.73, P <0.001) can be used as additional measures to GRS. CONCLUSION: The use of HMDs with stereoscopic and immersive video provides advantages in the learning experience and should be preferred over a traditional web application for e-learning. Contrary to expectations, feedback is not necessary for novices to achieve a sufficient level in suturing; only the number of surgical sutures performed during training is a good determinant of competence improvement. Nevertheless, feedback still enhances the learning experience. Therefore, automated assessment as an alternative feedback approach could further improve self-directed learning modalities. As a next step, the data from this study could be used to develop such automated AI-based assessments.

Virtual Reality in Biomedical Education in the sense of the 3Rs.

Article 23(2) of EU Directive 2010/63 on the protection of animals used for scientific purposes requires staff involved in the care and use of animals to be adequately educated and trained before carrying out procedures. Therefore, the 3Rs (refinement, reduction, and replacement) and knowledge of alternative methods should be part of the education and training itself. For this purpose, the digital learning concept "Virtual Reality (VR) in Biomedical Education" evolved, which successfully combines VR components with classical learning content. Procedures, such as anesthesia induction, substance application, and blood sampling in rats, as well as aspects of the laboratory environment were recorded in 360° videos. The generated VR teaching/learning modules (VR modules) were used to better prepare participants for hands-on training (refinement) or as a complete replacement for a live demonstration; thus, reducing the number of animals used for hands-on skills training (reduction). The current study evaluated users' experience of the VR modules. Despite little previous VR experience, participants strongly appreciated the VR modules and indicated that they believed VR has the potential to enhance delivery of procedures and demonstrations. Interestingly, participants with previous experience of laboratory animal science were more convinced about VR's potential to support the 3Rs principle, and endorsed its use for further educational purposes. In conclusion, VR appeared to be highly accepted as a learning/teaching method, indicating its great potential to further replace and reduce the use of animals in experimental animal courses.

UVA as environmental signal for alginate production in Pseudomonas aeruginosa: role of this polysaccharide in the protection of planktonic cells and biofilms against lethal UVA doses.

Pseudomonas aeruginosa is an extremely versatile microorganism that survives in a wide variety of niches. It is capable to respond rapidly to changes in the environment by producing secondary metabolites and virulence factors, including alginate. Alginate is an extracellular polysaccharide that protects the bacteria from antibiotics and oxidative agents, and enhances cell adhesion to solid surfaces in the process of biofilm formation. In the present study, we analyzed the role of alginate in the response of P. aeruginosa to lethal doses of ultraviolet-A (UVA) radiation, the major fraction of solar UV radiation reaching the Earth's surface. We also studied the role of alginate in the context of the adaptive responses generated when P. aeruginosa is exposed to sublethal doses of UVA radiation. The survival studies demonstrated that alginate has a key role in the resistance of P. aeruginosa to the oxidative stress generated by lethal UVA doses, both in planktonic cells and in static biofilms. In addition, the presence of alginate proved to be essential in the occurrence of adaptive responses such as induction of biofilm formation and cross-protection against hydrogen peroxide and sodium hypochlorite, both generated by exposure to low UVA doses. Finally, we demonstrated that the increase of biofilm formation is accompanied by an increase in alginate concentration in the biofilm matrix, possibly through the ppGpp-dependent induction of genes related to alginate regulation (algR and algU) and biosynthesis (algD operon). Given the importance of alginate in biofilm formation and its protective roles, better understanding of the mechanisms associated to its functions and synthesis is relevant, given the normal exposure of P. aeruginosa to UVA radiation and other types of oxidative stresses.

Effect of an endodontic e-learning application on students' performance during their first root canal treatment on real patients: a pilot study.

BACKGROUND: E-learning has found its way into dental teaching in general and endodontic teaching in particular. The present study aimed to implement a newly developed multimedia learning application and assess its effect on students' first root canal treatment on real patients. With the COVID-19 outbreak, the application's performance was investigated during the pandemic. METHODS: A total of 138 students in the initial clinical endodontic course participated in this study. The control group (n = 49) followed the traditional curriculum, including practice on artificial teeth and face-to-face teaching events. In addition to the traditional curriculum, test group 1 (n = 54) had access to an endodontic e-learning application containing videos demonstrating artificial teeth and patient cases. With the COVID-19 outbreak, test group 2 (n = 35) had no face-to-face teaching; however, endodontic patient treatments were included. The quality of students' first root canal treatment on real patients was compared using performance and radiographic assessment items. Statistical analysis was done using Kruskal-Wallis and chi-squared tests. Test groups received a questionnaire to assess the learning application. Test group 2 also completed a COVID-19-specific survey to measure students' perceptions of how the pandemic affected their endodontic education. RESULTS: The results of endodontic treatments were significantly better for test group 1 (P < 0.001) and 2 (P < 0.001) than for the control group. Likewise, there were significantly fewer treatment errors in test group 1 (P < 0.001) and 2 (P < 0.001). No significant differences were found between test groups 1 and 2. Students of the test groups positively evaluated the e-learning application. Students of test group 2 expressed their fear of negative impacts on their course performance. CONCLUSION: The e-learning application was well-received and seemed to improve endodontic education. The results imply that the quality of education may be maintained by implementing e-learning to compensate for face-to-face teaching. As no difference was found between online and face-to-face teaching, students' and lecturers' concerns that endodontic education is suffering because of the pandemic may be eased.

Digital Health and Learning in Speech-Language Pathology, Phoniatrics, and Otolaryngology: Survey Study for Designing a Digital Learning Toolbox App.

BACKGROUND: The digital age has introduced opportunities and challenges for clinical education and practice caused by infinite incoming information and novel technologies for health. In the interdisciplinary field of communication sciences and disorders (CSD), engagement with digital topics has emerged slower than in other health fields, and effective strategies for accessing, managing, and focusing on digital resources are greatly needed. OBJECTIVE: We aimed to conceptualize and investigate preferences of stakeholders regarding a digital learning toolbox, an app containing a library of current resources for CSD. This cross-sectional survey study conducted in German-speaking countries investigated professional and student perceptions and preferences regarding such an app's features, functions, content, and associated concerns. METHODS: An open web-based survey was disseminated to professionals and students in the field of CSD, including speech-language pathologists (SLPs; German: Logopäd*innen), speech-language pathology students, phoniatricians, otolaryngologists, and medical students. Insights into preferences and perceptions across professions, generations, and years of experience regarding a proposed app were investigated. RESULTS: Of the 164 participants, an overwhelming majority (n=162, 98.8%) indicated readiness to use such an app, and most participants (n=159, 96.9%) perceived the proposed app to be helpful. Participants positively rated app functions that would increase utility (eg, tutorial, quality rating function, filters based on content or topic, and digital format); however, they had varied opinions regarding an app community feature. Regarding app settings, most participants rated the option to share digital resources through social media links (144/164, 87.8%), receive and manage push notifications (130/164, 79.3%), and report technical issues (160/164, 97.6%) positively. However, significant variance was noted across professions (H3=8.006; P=.046) and generations (H3=9.309; P=.03) regarding a username-password function, with SLPs indicating greater perceived usefulness in comparison to speech-language pathology students (P=.045), as was demonstrated by Generation X versus Generation Z (P=.04). Participants perceived a range of clinical topics to be important; however, significant variance was observed across professions, between physicians and SLPs regarding the topic of diagnostics (H3=9.098; P=.03) and therapy (H3=21.236; P<.001). Concerns included technical challenges, data protection, quality of the included resources, and sustainability of the proposed app. CONCLUSIONS: This investigation demonstrated that professionals and students show initial readiness to engage in the co-design and use of an interdisciplinary digital learning toolbox app. Specifically, this app could support effective access, sharing, evaluation, and knowledge management in a digital age of rapid change. Formalized digital skills education in the field of CSD is just a part of the solution. It will be crucial to explore flexible, adaptive strategies collaboratively for managing digital resources and tools to optimize targeted selection and use of relevant, high-quality evidence in a world of bewildering data.

Interrater reliability in the assessment of physiotherapy students.

BACKGROUND: Reliable and objective assessment of psychomotor skills in physiotherapy students' education is essential for direct feedback and skill improvement. The aim of this study is to determine the interrater reliability in the assessment process of physiotherapy students and to analyse the assessment behaviour of the examiners. METHODS: Physiotherapy teachers from two different schools assessed students from two different schools performing proprioceptive neuromuscular facilitation (PNF) patterns. An evaluation sheet with a 6-point rating scale and 20 evaluation criteria including an overall rating was used for assessment. The interrater reliability was determined calculating an intraclass-correlation coefficient (ICC) and Krippendorff's alpha. The assessment behaviour of the examiners was further analysed calculating the location parameters and showing the item response distribution over item in form of a Likert plot. RESULTS: The ICC estimates were mostly below 0.4, indicating poor interrater reliability. This was confirmed by Krippendorff's alpha. The examiners showed a certain central tendency and intergroup bias. DISCUSSION AND CONCLUSION: The interrater reliability in this assessment format was rather low. No difference between the two physiotherapy schools concerning the interrater reliability could be identified. Despite certain limitations of this study, there is a definite need for improvement of the assessment process in physiotherapy education to provide the students with reliable and objective feedback and ensure a certain level of professional competence in the students. TRIAL REGISTRATION: The study was approved by the ethics committee of the Medical Faculty RWTH Aachen University (EK 340/16).

Teaching of Nuclear Cardiology in Times of Pandemic: Transfer of a Case-based Interactive Course from Classroom to Distance Learning.

AIM: While methods of independent study, such as problem-based learning, have been shown beneficial to students' learning outcome and motivation to self-educate, these concepts are currently challenged by the pandemic. The aim of the current study was the evaluation of the transfer of an interactive nuclear cardiology teaching module to an online, distance learning setting. METHODS: Two-hundred-forty medical students completed and evaluated the teaching module in a classroom and 127 students in the distance learning setting. RESULTS: The interactive, problem-based teaching module was transferred well into the distance learning setting during the pandemic. However, while the presented results suggest that distance learning is a good substitute for classroom teaching when in-person teaching is not possible, the distance teaching module was perceived less efficient in its course didactics, demands as well as applicability than the same module in a classroom setting. CONCLUSION: Although distance learning thus cannot entirely replace classroom education, it does provide a well-suited alternative method to teach particularly nuclear medicine and medicine in general. Future applications should offer introductory sessions, provide learning materials in advance and slow down the teaching pace to facilitate online, distance learning.

One year of COVID-19 pandemic: a cross sectional study on teaching oral and maxillofacial surgery.

BACKGROUND: The pandemic has challenged educational institutions to catalyze digitalization and rapidly develop online teaching formats. The aim of the study was to evaluate the teaching offered for oral and maxillofacial surgery at our university during the pandemic and to investigate the students' perceptions of the current situation. METHODS: A 38-item questionnaire with five sections (demographic information, lectures, internships, e-learning, and pandemic-related solutions/effects) was created online. Most questions were answered on a 10-point Likert scale, with 1 indicating "fully agree/positive" and 10 indicating "totally disagree/negative." The remaining questions were either answered with yes/no, percent value, or open-ended text responses. All 3rd-5th year dental students were invited to voluntarily participate and were sent a link by email in a general mail shot. RESULTS: A total of 63.7% of the participants had no prior experience with online courses before the pandemic. The students stated that the change from face-to-face to online teaching worked very well in the last two semesters (mean = 2.73, standard deviation = 2.05). Overall, the pandemic had a rather positive influence on the acquisition of theoretical skills and a negative influence on the acquisition of practical skills (p < 0.0001). The evaluation showed that, compared to other dental clinics at our university, the department for oral and maxillofacial surgery was well prepared for the pandemic. CONCLUSION: Digitalization of oral and maxillofacial surgery teaching in dental education is possible but depends on the institution's preparatory work and technological possibilities. The students declared a high acceptance of digital learning formats and indicated an increased motivation to learn due to e-learning. The pandemic's influence on the students' education was rated ambivalent.

Digital Health and Digital Learning Experiences Across Speech-Language Pathology, Phoniatrics, and Otolaryngology: Interdisciplinary Survey Study.

BACKGROUND: Advances in digital health and digital learning are transforming the lives of patients, health care providers, and health professional students. In the interdisciplinary field of communication sciences and disorders (CSD), digital uptake and incorporation of digital topics and technologies into clinical training programs has lagged behind other medical fields. There is a need to understand professional and student experiences, opinions, and needs regarding digital health and learning topics so that effective strategies for implementation can be optimized. OBJECTIVE: This cross-sectional survey study aims to interdisciplinarily investigate professional and student knowledge, use, attitudes, and preferences toward digital health and learning in the German-speaking population. METHODS: An open-ended, web-based survey was developed and conducted with professionals and students in CSD including phoniatricians and otolaryngologists, speech-language pathologists (German: Logopäd*innen), medical students, and speech-language pathology students. Differences in knowledge, use, attitudes, and preferences across profession, generation, and years of experience were analyzed. RESULTS: A total of 170 participants completed the survey. Respondents demonstrated greater familiarity with digital learning as opposed to eHealth concepts. Significant differences were noted across profession (P<.001), generation (P=.001), and years of experience (P<.001), which demonstrated that students and younger participants were less familiar with digital health terminology. Professional (P<.001) and generational differences were also found (P=.04) in knowledge of digital therapy tools, though no significant differences were found for digital learning tools. Participants primarily used computers, tablets, and mobile phones; non-eHealth-specific tools (eg, word processing and videoconferencing applications); and digital formats such as videos, web courses, and apps. Many indicated a desire for more interactive platforms, such as virtual reality. Significant differences were found across generations for positive views toward digitalization (P<.001) and across profession for feelings of preparedness (P=.04). Interestingly, across profession (P=.03), generation (P=.006), and years of experience (P=.01), students and younger participants demonstrated greater support for medical certification. Commonly reported areas of concern included technical difficulties, quality and validity of digital materials, data privacy, and social presence. Respondents tended to prefer blended learning, a limited to moderate level of interactivity, and time and space-flexible learning environments (63/170, 37.1%), with a notable proportion still preferring traditional time and space-dependent learning (49/170, 28.8%). CONCLUSIONS: This comprehensive investigation into the current state of CSD student and professional opinions and experiences has shown that incorporation of digital topics and skills into academic and professional development curricula will be crucial for ensuring that the field is prepared for the ever-digitalizing health care environment. Deeper empirical investigation into efficacy and acceptance of digital learning and practice strategies and systematic training and practical organizational supports must be planned to ensure adaptive education and practice.

An Evaluation of Forced Distance Learning and Teaching Under Pandemic Conditions Using the Technology Acceptance Model.

Research: Due to the sudden outbreak of COVID-19 and the resulting pandemic situation, universities were forced to rapidly change their traditional pedagogical and didactical approach by shifting from mostly face-to-face teaching to entirely virtual and online teaching methods. Through this, a "forced" distance learning and teaching situation emerged. This study aimed at investigating the effect of these innovations on the implementation, acceptance, and use of the virtual teaching offer within the framework of the technology acceptance model (TAM). Methods: A total of 218 students and 69 lecturers of a German Medical Faculty completed online questionnaires on the acceptance, satisfaction, and usefulness of the forced distance learning (FDL) and teaching (FDT), respectively. An extended version of the TAM was used to assess the acceptance of the students and lecturers of FDL and FDT. In order to estimate the multivariate dependencies, path analysis was employed using structural equation modeling (SEM). Results: In general, students and lecturers reported being satisfied with the implementation of the FDL and FDT. Regarding the TAM model, the fit indices suggested an acceptable model fit for both groups. The model of the students revealed that the perceived usefulness had a strong predictive power on the attitude toward using and the perceived ease of use also predicted the attitude. The existing technical infrastructure as well as the general media affinity and pandemic-related worries proved to be positively associated with the perceived usefulness while data security worries and organization of online teaching predicted the perceived ease of use in students. The strong positive predictive power of the perceived usefulness for the attitude toward using was also evident in the model for the lecturers and the technical infrastructure predicted the perceived ease of use in the lecturers. Conclusion: The TAM is a suitable framework to represent the implementation, acceptance, and use of the virtual teaching offer during the special pandemic situation at the university. However, personal and structural context factors were important predictors for the perceived usefulness and the perceived ease of use in the student group. The forced situation for learning and teaching makes it more difficult to predict the actual use of virtual teaching offers solely based on attitude.

Transferring the sandwich principle to instructional videos: is it worth the effort?

BACKGROUND: The sandwich principle is an educational concept that regularly alternates between collective and individual learning phases within one learning unit. Applying sandwich principle to lectures has proven to be more effective for learning outcomes than classical lectures. Supposedly, this teaching format also leads to a beneficial knowledge transfer when applied to other teaching formats. Therefore, the aim of this study was to investigate the effect of the sandwich principle on instructional videos and how its use was evaluated by students. METHODS: Participants (n = 51) were randomly allocated into two groups. Both groups were given a test to assess the baseline level of knowledge. Afterwards, the control group watched the normal instructional video on cleft lips and palates, while the sandwich group watched the same video modified according to the sandwich principle. The participants then had to answer 30 single-choice questions to assess their knowledge gain and evaluate the instructional video. Long-term retention of the knowledge was tested again 6 months later using the same test questions. The unpaired t-test and ANOVA were used to compare the results. RESULTS: Comparison of the pre-test and post-test results of both groups showed significantly increased test scores (p < 0.0001). Regarding long-term retention, the mean test scores were still significantly higher in both groups than before watching the video (p < 0.0001). For all test results, there was no significant difference between the groups (p > 0.05). The evaluation showed that the students highly appreciated the modified video and found the interruptions for repetition of previously learned knowledge useful. CONCLUSION: The hypothesis that the modification of instructional videos according to the sandwich principle would lead to an improved learning outcome could not be proved subjectively or objectively. Nevertheless, the teaching format was highly appreciated by the students and may have increased their motivation to learn with instructional videos.

Development of a tailor-made surgical online learning platform, ensuring surgical education in times of the COVID19 pandemic.

BACKGROUND: During the worldwide COVID-19 pandemic, the quality of surgical education experiences sudden major restrictions. Students' presence in the operating theater and on wards is reduced to a bare minimum and face-to-face teaching is diminished. Aim of this study was therefore to evaluate alternative but feasible educational concepts, such as an online-only-platform for undergraduates. OBJECTIVE: A new online platform for undergraduate surgical education was implemented. A virtual curriculum for online-only education was designed. METHODS: A video-based online platform was designed. Following this, a cohort of medical students participating in a (voluntary) surgical course was randomized into a test and control group. Prior to conducting a written exam, students in the test group prepared using the video platform. Students in the control group prepared with standard surgical text books. Results of the exam were used to compare educational means. RESULTS: Students in the test group preparing through the video-based online platform reached significantly higher scores in the written exams (p = 0.0001) than students of the control group. A trend towards reduced preparation time that did not reach statistical significance was detectable in the test group (p = 0.090). Scores of "perceived workload" and "desire to become a surgeon" offered no differences between the groups. (p = 0.474 and 1.000). CONCLUSIONS: An online-only, virtual curriculum proved feasible for surgical education in undergraduates. While blended learning concepts were applied in both groups, only the test group had access to case-based videos of surgical procedures and scored significantly better in the written exams. Thus, video-based virtual education offers a realistic alternative to face-to-face teaching or conventional text books in times of restricted access to the operating theatre.

Effectiveness of face-to-face, blended and e-learning in teaching the application of local anaesthesia: a randomised study.

BACKGROUND: Local anaesthesia plays a key role in many aspects of a dentist's work. The required skills to perform anaesthesia successfully are acquired at university. To take advantage of the possibilities for new teaching formats, a blended learning concept for the local anaesthesia course was developed. The aim of the study was to compare the effectiveness of face-to-face, blended and e-learning in teaching in local anaesthesia by assessing students' knowledge gain, performance of practical skills and satisfaction with the course. METHODS: All participants (n = 37) were randomly allocated into three groups. After acquiring the theoretical background in the blended learning, e-learning or lecture groups, a test to assess knowledge gain was performed. The performance of the practical skills was assessed in a small-group seminar. Student attitudes were evaluated with a questionnaire. RESULTS: The blended group showed significantly better results (mean = 17, SD =1.5) in theoretical knowledge gain than the other two groups (e-learning group: mean = 14.7, SD = 2.2; lecture group: mean = 14.8, SD =2.3). When comparing the results of the clinical skills assessment, there was no significant difference among all three groups (p > 0.017). The participants confirmed a high overall satisfaction with the course, in particular with the blended learning approach. CONCLUSION: This study indicates that blended learning improves the learning outcome for theoretical knowledge in teaching local anaesthesia more than either face-to-face learning or e-learning alone. Furthermore, the blended learning approach is highly appreciated by the students. For acquiring practical skills, this study shows that blended learning is as effective as other teaching methods.

The Sandwich principle: assessing the didactic effect in lectures on "cleft lips and palates".

BACKGROUND: A teaching concept, that takes individual learning and personal belongings into account, is called the "sandwich principle." This didactic method is an educational concept that alternates consecutively between individual and collective learning phases during a course. This study aimed to prove whether the application of the sandwich principle in lectures increases the learning outcome compared with classical lectures. METHODS: All participants (n = 64) were randomly allocated into two groups. One group attended a classical face-to-face lecture and the other attended a lecture that was modified according to the sandwich principle, including activating elements. To compare knowledge gain after the lectures, all the participants had to answer a test comprising40 single-choice questions. In addition, the lectures were evaluated. RESULTS: Students attending the sandwich lecture had significantly better scores in the test than those who attending the classical lecture (p <  0.001). The mean test score of the sandwich group was 63.9% [standard deviation (SD) = 10] points and of the control group 50.2% (SD = 13.7 points). Overall, both the class conditions showed good evaluation results; however, students of the sandwich lecture were more satisfied with the lecture format compared with the other group. CONCLUSION: Our study results confirm the thesis that the application of the sandwich principle in lectures increases the learning outcome compared with classical lectures. Even with a big audience, the sandwich design presents a concept that helps maintain high attention levels and addresses individual learning styles.

Pilot study of a newly developed eLearning tool to teach CT and PET/CT in radiology and nuclear medicine.

AIM: To test the usability and user experience of a newly self-developed eLearning tool to teach PET/CT and CT to undergraduate medical students. METHODS: The eLearning tool permits to display PET and CT DICOM images web-based. It contains a healthy subject with anatomical annotations and a clinical case study. The usability and user experience of the eLearning tool was evaluated in undergraduate medical students of the medical faculty of the RWTH Aachen. We applied a survey based on different already existing and validated questionnaires such as System Usability Scale (SUS) and User Experience Questionnaire (UEQ-S) as well as specific questions regarding the eLearning tool. RESULTS: 38 volunteers (9 males) participated in our study. Applying the SUS resulted in a mean of 82.24, and a median of 83.75. This positive evaluation is supported by the results of the UEQ-S that were 2.2 with regard to the pragmatic quality, 2.3 with regard to hedonic quality and 2.3 for overall quality indicating a very positive evaluation. In the free-text answers, students emphasised easy and intuitive use of the eLearning tool that was additionally described as interesting and exciting. The students also positively mentioned the case study and the possibility of practice-based learning. Negative aspects were mainly problems with synchronisation of the PET and CT images. CONCLUSION: The positive evaluation is encouraging and form a foundation for further development of the eLearning module. It may be the basis for the implementation of a sustainable blended learning concept in the nuclear medicine curriculum.

Implementation of a Terminology Server with SNOMED CT in Graph Databases.

This paper described the implementation of a terminology server performed at a health institution in Uruguay, whose architecture is based on SNOMED CT using graph databases (NoSQL). The aim of this development was to create an intuitive terminological service, making the most of SNOMED CT's ontology, and which can be used from a clinical, statistical, management, decision support and research point of view, among others, with good performance.