Impact of virtual case-based collaborative learning compared to virtual lectures to teaching critical appraisal of medical literature in fourth-year medical students, a pilot mixed methods study.

Abstract

Introduction: Evidence-based medicine (EBM) is a practice that allows clinicians to implement the best available evidence for our patients. However, there is no best way to teach EBM, and multiple strategies have been implemented with mixed results. Methods: The purpose of this study was to compare two approaches to teaching EBM and explore their relative effectiveness in student self-perceived knowledge, skills, and experiences. We compared a virtual version of a relatively new active-learning approach, case-based collaborative learning (CBCL), with a virtual version of a traditional lecture. A pilot explanatory sequential mixed method design was performed. Quantitative data were obtained from tests and surveys and qualitative data from focus group discussion interviews and open-ended survey questions. Results: Ninety-nine students participated in the study, 49 in the VCBCL group and 50 in the VL group. Minimal expected retention and recruitment rates were achieved for this pilot. Knowledge and skill scores were high in both groups (20/20 in VCBCL and 19.5 in VL group, p=0.067). Both groups reported high quality and engaging sessions; in the VL group, class participation increased at the end of the study (p=0.047), but only in the VCBCL group students felt more comfortable sharing challenging opinions (p.001). Three themes and 13 subthemes emerged from the qualitative analysis of focus group and open-ended survey data, with student experience of “engagement” as a central organizing theme. A conceptual model with engagement at the center describes the students’ experiences and motivational states along 5 interrelated dimensions, specifically: student, facilitator skills, group learning experiences, instructional design, and learning environment. VCBCL promoted engagement by aligning with all the model elements and promoting a high degree of intrinsic motivation. VL, lacking the “group” factor and peer interactions, appeared to be associated with less intrinsic motivation. While this situation reduced engagement, it was partially compensated by a good instructional design and facilitator skills. Conclusions: Although students in virtual case-based collaborative learning (VCBCL) and traditional lecture groups performed similarly well in quantitative measures of knowledge and skills in evidence-based medicine, there were notable qualitative differences in the two approaches, with VCBCL students describing higher levels of engagement in classroom learning and greater levels of intrinsic motivation. Pilot implementation of the VCBCL approach was feasible even in the context of a university that otherwise is entirely lecture-based. Given equal levels of facilitator skills in teaching in these methods, VCBL appears to be the superior method by fostering students’ participation in solving higher order thinking clinical problems, encouraging interaction with peers, and in supporting students’ sense of autonomy, competence and relatedness.