Enriching the clerkship curriculum with blended e-learning.

Context and setting The pre-clinical years of undergraduate medical education have recently witnessed a shift away from the traditional, lecture-based model of teaching towards new instructional methods designed to encourage student-centred learning. Blended e-learning, which combines online self-study modules with face-to-face teaching, can be used to achieve this goal. Although the use of blended e-learning in the pre-clinical years has been described in the literature, there have been few reports about this method of instruction at the clinical clerkship level. Why the idea was necessary Prior to this project, formal clinical clerkship teaching at our university involved didactic weekly seminars presented by faculty members. Rising enrolment without any increase in the number of teachers led us to investigate novel methods of content delivery. The purpose of this project, therefore, was to improve teaching for clinical clerks at our institution while maximising the quality of the time spent with teaching faculty. What was done A web-based module was created to complement the material covered in the existing clinical clerkship seminar ‘Acute Hand Injuries’. The objectives for the module were developed with reference to national specialty society objectives as well as those published by the Medical Council of Canada. The module was presented as a series of authentic clinical cases and included self-assessment questions with embedded feedback. Given the solid theoretical foundation provided by completion of the new module, the existing 60-minute didactic seminar was modified into a 30-minute session that focused on the consolidation of knowledge through a review of relevant cases. The effectiveness of this blended e-learning model was compared with that of our traditional approach. One group of clinical clerks attended the traditional, expert-led seminar and another completed the new case-based, online module and then attended the shorter session with the same expert, who facilitated discussion and answered questions. Both groups then completed a content-based quiz and participated in focus groups designed to better understand the students’ reactions to their learning experience. Evaluation of results and impact Although the number of students was too small for statistical significance, the group that completed the online module scored 1.15 marks (out of 10) more on the content-based quiz than the group that attended the didactic seminar. During the focus group sessions, it became clear that students who had completed the module and subsequent follow-up session felt more engaged during the seminar and were more confident about applying their knowledge to cases. Other benefits included consistency of instruction and flexibility of use. It was concluded that this blended e-learning approach should be implemented in clerkship teaching as it enriches the student learning experience by increasing student engagement and encouraging active learning. At present, three modules have been completed and are in use; two others are in development. We anticipate that blended e-learning with the use of online modules will become a central part of our clinical clerkship curriculum. These resources will be shared with other institutions by means of submission to digital repositories.