Lessons Learned From Piloting an Early Version of a Locally Produced E-Learning Resource for Clinical-Year Medical Students: A Randomised Mixed Methods Study in Cape Town, South Africa

Abstract

Reputable subscription-based resources are available to students during medical school. However, they lose access to these resources upon graduation. To mitigate the issues around information access and learning during internship, a plan was made to develop and test a contextually relevant multimedia platform that could be used during medical school and beyond. A randomised mixed methods study was conducted among clinical-year medical students (years four to six) at the University of Cape Town. Participants were randomised into 2 groups using stratified block randomisation. Group 1 participants used UpToDate (UTD) to learn about breast masses and Four Minute Medicine (4MM) to learn about jaundice. Group 2 participants used 4MM to learn about breast masses and UTD to learn about jaundice. Students then completed a posttest, a post-posttest survey, and an optional interview. The posttest scores, knowledge and confidence ratings, and user experience preference ratings were analysed. Content analysis was used to analyse the qualitative data. Forty-nine students enrolled into the study. Thirty students (61%) completed the study and 15 students were interviewed. The differences between the UTD and 4MM breast mass scores (p = .57) and jaundice scores (p = .19) were not statistically significant. Most of the UTD and 4MM users’ self-perceived median knowledge and confidence ratings improved. With regard to the user experience preference ratings, four out of the eight domain ratings were statistically higher for 4MM. These domains were ease of use (p < .001), visual design (p < .001), interactivity (p < .001), and self-assessment capabilities (p = .01). UTD was rated as being more trustworthy (p < .001). From the interviews three 4MM feedback themes were identified: the ability to attract and support attention, the ability to facilitate understanding, and dependability. Four Minute Medicine was unable to demonstrate better test performance or greater improvements in self-reported knowledge and confidence. The qualitative feedback highlighted that its educational utility and value could be improved upon by addressing key design, usability and reliability issues.