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E-IJD® - ORIGINAL ARTICLE
Year : 2022  |  Volume : 67  |  Issue : 4  |  Page : 477
Applying the student response system in the online dermatologic video curriculum on medical students' interaction and learning outcomes during the COVID-19 pandemic


1 From the Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center; Graduate Institute of Medical Sciences; Department of General Medicine, Tri-Service General Hospital, Taipei, Taiwan
2 Department of General Medicine, Tri-Service General Hospital, Taipei, Taiwan
3 Department of Rheumatology/Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
4 School of Public Health, School of Medicine, National Defense Medical Center, Taipei, Taiwan
5 From the Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center; Graduate Institute of Medical Sciences; Vice Chairman, School of Medicine, National Defense Medical Center, Taipei, Taiwan

Date of Web Publication2-Nov-2022

Correspondence Address:
Wei-Ming Wang
Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei City 114
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_147_22

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   Abstract 

Background: The coronavirus disease 2019 (COVID-19) pandemic impacted medical education worldwide. Online lecture is increasingly prevalent in higher education, but students' completion rate is quite low. Aims: This study aimed to determine the effectiveness of the student response system (SRS) in the online dermatologic video curriculum on medical students. Methods: A prospective study was conducted on 176 undergraduate fourth-year medical students. The online video lecture was integrated with SRS. Results: A total of 173 students completed the pre-test, and the attendance rate (pre-test/total) was 98.3%. A total of 142 students completed the post-test, and the completion rate (post-test/pre-test) was 82.8%. The post-test score (83.69 ± 4.34) was found to be significantly higher than that of the pre-test (62.69 ± 6.08, P =0.0002). A total of 138 students completed the questionnaire, and 92% of students opined that SRS was easy to operate. 86% of students agreed with the fact that the use of SRS could increase their learning performance by interacting with teachers. In the open-ended question, students stated that SRS offered opportunities for student–faculty interaction, allowed them to get immediate feedback, and promote active participation. Conclusions: These results highlight that the integration of SRS in the online video curriculum increases students' completion rates and learning outcomes. Moreover, the SRS is easy to operate for the students and enhances student–faculty interaction. The SRS may be adopted in online learning during this challenging time.


Keywords: COVID-19, engagement, online dermatologic curriculum, student response system


How to cite this article:
Hung CT, Fang SA, Liu FC, Hsu CH, Yu TY, Wang WM. Applying the student response system in the online dermatologic video curriculum on medical students' interaction and learning outcomes during the COVID-19 pandemic. Indian J Dermatol 2022;67:477

How to cite this URL:
Hung CT, Fang SA, Liu FC, Hsu CH, Yu TY, Wang WM. Applying the student response system in the online dermatologic video curriculum on medical students' interaction and learning outcomes during the COVID-19 pandemic. Indian J Dermatol [serial online] 2022 [cited 2022 Dec 4];67:477. Available from: https://www.e-ijd.org/text.asp?2022/67/4/477/360313



   Introduction Top


The emergence of the coronavirus disease 2019 (COVID-19) pandemic has caused an unprecedented disruption in medical education worldwide. A 1 hour didactic lecture is one of the teaching methods used to deliver the knowledge to a large group of students. However, as most students are passive listeners, the lecture ends up as a one-sided teaching session. Currently, medical students are unable to attend in-person classes, and didactic lectures are transited to online platforms. Online lectures in medical education have become prevalent with the advancement of technology and play important roles.[1],[2],[3],[4],[5] It offers students convenience and flexibility in terms of scheduling, circumstances, and transportation.[6] However, learning online is challenging. The average completion rate of massive open online courses is less than 10%.[7] Besides, there is controversy about whether students do equally well in online courses as they do in face-to face courses. Some studies revealed that online students got lower grades and pass rates than face-to-face students.[8],[9] This study aimed to determine the effectiveness of the student response systems (SRSs) in the online dermatologic video curriculum at Taiwan medical school.


   Materials and Methods Top


Ethics

This study was reviewed and approved by the Institutional Review Board of Tri-Service General Hospital (TSGHIRB No.: C202105012).

Study design and participants

This study was performed on 176 undergraduate fourth-year medical students, including 125 males and 51 females, at the National Defense Medical Center (NDMC), Taiwan. The online dermatologic video lecture was integrated with SRS. The SRS in this study adopted Zuvio, an online teaching platform that provides an interactive feedback system. Zuvio could be conducted on mobile phones, tablets, or computers. The students could log in to Zuvio to answer the pre-test/post-test, ask questions, make responses, and fill in the questionnaire [Figure 1].
Figure 1: The user interface of SRS. The students can log in the SRS by their mobile phones. (a) They can answer the pre-test/post-test and fill in the questionnaire. (b) They can ask questions and interact with teachers. (c) They can link the online educational video directly

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The online lecture was designed with the pre-test and post-test of five different quiz reviewed by five dermatologists. The lecture began with the pre-test, and the post-test was performed immediately after the lecture. The questionnaire was focused on assessing students' experiences of SRS and opinions about the lectures [Table 1]. Students specified their level of agreement to 10 statements with a quantitative 5-point Likert-type response scale, ranging from 1 (strongly disagree, the lowest degree) to 5 (strongly agree, the highest degree). Two open-ended questions, those that cannot be offered by the quantitative measures, were provided to students to express their opinions and feedback on SRS and teachers [Table 2].
Table 1: Students' responses to the lecture and SRS

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Table 2: Students' opinions on SRS

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Data analysis

The pre-test and post-test scores were expressed as the mean ± standard deviations (SDs), and the comparison is performed by paired t-test. A two-tailed P value less than 0.05 was deemed to be statistically significant. Microsoft Excel 2016 was used to analyse the data.


   Results Top


Attendance rate and completion rate of the lecture

This study was conducted on undergraduate fourth-year medical students. A total of 176 students, including 125 males and 51 females, participated in the lectures on cutaneous systems. A total of 173 students, including 122 males and 51 females, completed the pre-test, and the attendance rate (pre-test/total) was 98.3%. A total of 142 students completed the post-test, and the completion rate (post-test/pre-test) was 82.8%. Higher attendance rates and completion rates were observed in female students when the sub-group analysis by gender was performed.

Pre-test and post-test scores

The pre-test and post-test scores were collated and expressed as a mean score ± SD to find out the students' learning efficiency. The post-test score (83.69 ± 4.34) was found to be significantly higher than that of the pre-test (62.69 ± 6.08, P =0.0002).

Students' responses to the lecture and SRS

A total of 138 students completed the questionnaire on using SRS in the lecture [Table 1]; a total of 127 (92.02%) students agreed that SRS was easy to operate, and 119 (86.23%) students accepted the use of SRS during the lecture and agreed that SRS could increase their learning performance. The pre-test was designed for the students to know the learning issues of lecture (86.96% agreed), and the post-test was arranged to self-assess learning performance (97.10% agreed). Real clinical cases and questions of medical licensing examination were integrated to impress the students and increase their willingness to complete the lecture (97.10% and 90.58% agreed, respectively).

Students' opinions on SRS

Feedback was taken from 108 students on the use of SRS in the lecture, and it is summarized in [Table 2]. All these students perceived SRS as a user-friendly platform. They stated that SRS offered opportunities for collaborative learning and student–faculty interaction, allowed them to get immediate feedback, and promote active participation. It could increase students' participation and keep them thinking and not just listening. The design of the pre-test and post-test helps students to learn with a deep conceptual understanding.


   Discussion Top


Online learning modules and open online courses are becoming popular in medical education.[2],[10] Online curriculum offers great flexibility to students and thus increases the attendance for lectures. However, less than 10% of the students who start an online lecture could finish it.[7] This study included SRS in the online curriculum, and the completion rate of the online video lecture was found to be significantly higher than that reported before (82.8%). Previous studies have shown a positive correlation between the attendance of medical students and their academic performance.[11],[12],[13] The attendance rate and completion rate of female students were found to be higher than those of male students in this study. However, gender differences in academic performance could not be analysed because of the anonymous results of the pre-test and post-test in this study. Further study is needed to know the influence of gender on lecture completion rate and examination performance.

Zuvio was perceived as a user-friendly SRS application, which is available free in the Google Play Store and Apple's App Store. The students can participate by scanning the QR code. In 2016, Su CF et al.[14] used Zuvio in teaching physicians about diagnostic reasoning, and most attendees expressed their satisfying experience as feedback, such as increased concentration, better participation in discussion, improved interaction with peers and teachers, and so on. In this study, up to 127 (92.02%) students agreed that SRS was easy to operate, and 119 (86.23%) students agreed with the application of SRS in the lecture.

Formative assessment, highlighted by Black and Wiliam's review, is designed to provide feedback on improving learning, in particular deep learning.[15],[16] It works best when the assessment is included in the lecture, providing specific and suitable feedback timely.[17] With the development of the internet and available mobile devices, the applications of information and communication technologies (ICTs) have increased in the field of assessment.[14],[18],[19] Formative assessment was performed in this study by SRS in the online lectures. Instructors could design the pre-test and post-test in the SRS platform, and all attendees could answer the questions by mobile electronics. The instructors could understand if the students previewed the lecture content or not. Students could propose their questions anonymously by SRS. Instructors could make the response and feedback appropriately. In this study, 114 (82.61%) students agreed that SRS could enhance their engagement and focus on the lecture. The score of the post-test was significantly higher than that of the pre-test (P =0.0002). The learning efficiency improved, and 119 (86.23%) students agreed that SRS could increase their learning performance.

This study also aimed to determine if the pre-test and post-test improve the completion rate of the online lecture. Students remarked that the pre-test helped them to get the important content of the next sections, and they could self-assess their learning efficiency by the post-test. A total of 134 (97.10%) students agreed with “I could check my learning performance by post-test,” and 120 (86.96%) students agreed with “I could know the learning issues of the lecture by a pre-test.”

There were some limitations in this study. First, this was a single-observation study with the online dermatologic video lecture integrated with SRS. Thus, the strengths and weaknesses of SRS could not be elucidated in the continuous curriculum. Second, one teacher used SRS in the online dermatologic curriculum. There were seven different teachers involved in the dermatologic education section, and we did not know if there was any operating difficulty for them. However, this is a pilot study, and the application of SRS will be extended to the whole dermatologic section in the future. The qualitative and quantitative feedback from teachers will be collected. Third, students logged in to SRS anonymously to give their feedback freely. Thus, the individual improvement could not be analysed after lectures. Forth, Zuvio, the SRS applied in this study, supports Traditional Chinese and English, but it was only available in Taiwan.


   Conclusion Top


Our study highlights that the integration of SRS in the online video curriculum increases students' completion rates and learning outcomes. Moreover, the SRS is easy to operate for the students and enhances student–faculty interaction. The SRS may be adopted in online learning during this challenging time.

Financial support and sponsorship

This study was supported by grants from Tri-Service Hospital Research Foundation (TSGH-D-110078 and TSGH-E-111201). The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.

Conflicts of interest

There are no conflicts of interest.



 
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