EVALUATION OF A WEB-BASED
TEACHING MODULE ON
EXAMINATION OF THE HAND
Henry Averns
The Challenge
• Difficult to develop an approach that is
– consistent,
– clinically relevant and
– Succinct
The Challenge 2
•Lack of a standardized approach
presented by different specialists
•Level of detail in textbooks and manuals.
•Financial constraints at institutions,
•Reduced tutor availability
•Increasing pressure on the medical
curriculum
Objectives
• To evaluate the effectiveness of an on-line
module in the development of medical
students’ clinical hand examination skills.
Methods
• Web-based module to teach physical
examination of the hand to first year medical
students (n=99)
• Module was compared to the standard
recommended text and tutor led teaching
• Assessed using a validated OSCE and a written
knowledge test.
Core skills
• The web-based module and tutor-led MCC
Objectives
• Regional Examination of the Musculoskeletal
System (REMS) core set
Task Analysis
Before you can tell
someone else how
to do something,
you have to
articulate the
steps to yourself.
By Mitchell Rabinowitz
Contributor Mitchell Rabinowitz
Published by Lawrence Erlbaum Associates,
1993
ISBN 0805812792, 9780805812794
239 pages
How To Do a Task Analysis
1. Remind yourself of the objective and the degree of mastery
required
2. Observe experts and take notes as they do the task.
3. Take notes as you observe an expert achieve the objective.
4. Slow down experts so that you can identify each step.
5. Ask the experts to speak aloud and say
what they are doing
why they are doing it
what warning they would issue (or remind themselves of)
how do they know if a step has succeeded
how do they know if a step has failed
6. List what you learned that you did not expect to
The objectives of the hand teaching
were to;
• Develop a standard
• Recognize a range of clinical signs and
understand the relevance of
• Recognize and describe the classical patterns
of joint involvement in rheumatoid arthritis
and osteoarthritis.
• Be aware that other (i.e. non-rheumatological)
diseases can result in clinical signs in the
hands
The module
• sequence of the examination
• photographs demonstrating a range of
possible conditions which could be seen on
inspection,
• photographs showing clearly how to palpate
and move the joints,
• discussion of pattern recognition in
osteoarthritis and rheumatoid arthritis,
LINK TO MODULE
Assessment
• OSCE
• Knowledge test
Group 1
• practical session led by a rheumatologist
taking them through the
• discussion of possible findings at each stage
with an
• initial PowerPoint
• tutor watching and ensuring correct clinical
method.
Group 2
• On-line module.
• They did not have practical teaching.
• Access to the web based module was limited
to that group by username and password to
avoid contamination of the other two groups.
Group 3
• Recommended text on hand examination
Analysis
• Null Hypothesis: The average total OSCE score
is the same between students randomized to
the standard text method compared to the
online module teaching method
• Null Hypothesis: The average total OSCE score
is at least 10% higher with the tutor -led
teaching technique than with the online
module.
Results
• Based on a total of
– 17 students who completed the OSCE from the
book based learning group,
– 18 from the formal teaching group, and
– 26 from the on-line module group.
• Interesting sabotage in the CEC…a lesson for
the future
Table 1
Demographics of teaching groups
Learning Method
N
Mean age
Std Dev
% female
Book
17
24.5
3.3
45.5
Formal
18
24.7
3.1
45.5
Module
26
25.1
3.4
47.1
Table 2
Total OSCE % by group
Learning
Lower 95%
Upper 95%
Method
N
Mean
Std Dev
CL for Mean
CL for Mean
Book
17
60.5
12.9
53.9
67.1
Formal
18
69.0
14.2
62.0
76.1
Module
26
73.2
12.5
68.2
78.3
Table 3
Total knowledge score by group (maximum score of 10)
Learning
Method
Mean
Std Dev
Lower 95%
Upper 95%
CL for Mean
CL for Mean
Book
17
5.7
2.5
4.4
7.0
Formal
18
7.4
1.7
6.6
8.3
Module
26
8.4
1.3
7.9
9.0
Conclusion
• This study provides evidence that a well
designed web-based module, underpinned by
sound educational theory, is an effective tool
in the teaching of musculoskeletal
examination skills, as well as providing some
advantages over tutor-led teaching in terms of
knowledge retention.
Why?
• Defining clear terminal objective
• Sequence
• Task analysis principles (cf video etc)
What we would do differently
• Design issues – bank of non copyrighted
pictures
• Avoid sabotage
• Hawthorne effect
– knowledge of the planned OSCE would have acted
as a strong motivator for learning
Discussion
• Resource implications
• Using other Universities modules
• Role of videos