|PRACTICAL ADVICE PAPER
|Year : 2015 | Volume
| Issue : 1 | Page : 101-105
Creating a blended learning module in an online master study programme in oncology
Benjamin Mayer1, Christina Ring2, Rainer Muche1, Dietrich Rothenbacher1, Uta Schmidt-Straßburger3
1 Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
2 Leicester, United Kingdom, United Kingdom
3 Division of Learning and Teaching, Medical Faculty, Ulm University, Ulm, Germany
|Date of Web Publication||31-Jul-2015|
Institute of Epidemiology and Medical Biometry, Ulm University Schwabstr. 13, 89075 Ulm
Source of Support: None, Conflict of Interest: None
Background: The medical faculty of Ulm University has launched the postgraduate master online study programme Advanced Oncology (AO) in 2010. We describe the challenges in developing an e-learning module using the example of a medical biometry course, focusing the implementation of the course material and our single-loop learning experience after the first students have finished and evaluated the lecture. Methods: Programme participants are qualified medical doctors and researchers in biomedical areas related to the field of oncology. The study programme provides the majority of lectures online via didactic videos accompanied by one-week attendance seminars. Supplementary learning materials include review articles, supportive reading material, multiple choice questions, and exercises for each unit. Lecture evaluations based on specific questions concerning learning environment and information learned, each measured on a five-point Likert scale. Results: Lecture videos were implemented following the classical triad of the didactic process, using oncological examples from practice to teach. The online tutorial support offered to students was hardly used, thus we enhanced faculty presence during the face-to-face seminars. Lecture evaluations improved after revising the learning material on the basis of the first AO student cohort's comments. Discussion: Developing and implementing an online study programme is challenging with respect of maximizing the information students learn due to limited opportunities for personal contact between lecturers and students. A more direct interaction of lecturers and students in a blended learning setting outperforms a mere web-based contact in terms of learning advantage and students' satisfaction, especially for complex methodological content.
Keywords: Blended learning, e-learning, medical biometry, medical didactics, oncology
|How to cite this article:|
Mayer B, Ring C, Muche R, Rothenbacher D, Schmidt-Straßburger U. Creating a blended learning module in an online master study programme in oncology
. Educ Health 2015;28:101-5
| Background|| |
E-learning has become an essential aspect of university education , due to the rapid development of modern communication technologies enabling this form of teaching methodology and the attached benefits for students as well as lecturers. In particular, the advantages of e-learning from a student's perspective are the individual design of the didactic environment, a flexible organization of time for learning and an unlimited access to the original learning material. 
A backbone of new insights in the treatment of cancer is substantiated research, therefore a module covering "Clinical Research" should be part of an educational master programme in this field. Medical biometry is a significant branch of clinical research, since it provides the statistical methods for analysing and interpreting trial data. A basic knowledge of the most common statistical methods, their appropriate use and evidence to answer a research question are essential skills for physicians and for scientists involved in clinical research.
The implementation of an e-learning module, especially in medical biometry, is challenging for various reasons. Direct contact between students and lecturers facilitates learning in situations where complex methods must be taught comprehensibly to be understood by students. Medical biometry is also not the most popular discipline among students, and its importance and reason for being part of the curriculum is often misjudged. These obstacles can often be clarified through discussion, but this is difficult in an e-learning course. Online education, and even setting learning objectives, can also be challenged where there is diversity among learners, who can vary in age, nationality and baseline knowledge.
In this paper, we offer practical advice on developing, implementing and refining a web-based online master programme in oncology using the example of a medical biometry lecture, for the purpose of helping teachers in other institutions and in related fields. We present important aspects of creating a basic curriculum in a blended learning setting and offer our experiences from launching a postgraduate master online programme in Advanced Oncology (AO) at the medical faculty of Ulm University, Germany. The target audience for this online programme includes clinical oncologists and other scientists in the field of oncology working in the academic and public health sectors and in the pharmaceutical industry.
To plan and implement a lecture for an online master course requires a conscientious examination of the main aspects of e-learning and medical education in general. We developed a learner-oriented quality concept for the AO programme by incorporating study findings on learner's subjective preferences for high quality education  in order to move beyond an early adopter's stage.  The AO programme provides a wide range of learning options and support for e-learners to provide for self-regulated and active learning.
The presentation of contents in various sense modalities is a core element of learning through digital media , and facilitates an individual's learning.  New media provides various ways of imparting content to meet a student's preferred learning approach. There are options for providing content visually, audibly, and practically, but the emphasis should be on the spoken language over the written.  Overall, the choice of e-learning modality should be guided by the fundamental principles of the classical triad of the didactic process-access, work and closure phase-to facilitate students' learning. 
An important aspect of medical education is to impart information through appropriate examples. This helps to minimize information left for learners at only the abstract level and enables future clinicians to more readily apply their knowledge in their care. In light of the complex and abstract nature of medical biometry, it is particularly important to find ways to transmit concepts vividly and by appropriate means. Appropriate presentation approaches should include ample clinical examples, clear and descriptive speech, and appropriate animation tools.
| Methods|| |
Ulm University was founded in 1967 and has a strong focus on scientific as well as medical (and especially oncological) research and education. It currently has more than 10,000 students. The postgraduate master online programme in AO is divided into modules that cover relevant fields of oncological research. Most lectures are provided online via didactic videos, which enable students from all parts of the world to study part-time. Supplementary material for further learning is posted on a Moodle-based learning platform.  Lecture material for each module is available on-line for three months, and students have unlimited access to the material during this time. At the beginning of the master programme and then after each term, students come together in one-week face-to-face seminars to write their exams, undertake soft skills training, prepare for the upcoming modules and to network.
The cornerstones for the learning material were the preparation of didactic videos, each of a maximum length of 45 min, with information presented as a verbally supported Microsoft PowerPoint presentation. Each video lecture has supplemental material, which included two-page review articles, a summary of the key messages, supportive reading material and multiple choice questions and exercises to enable students' self-examination. In order to implement the already mentioned triad of the didactic process, we additionally defined learning objectives for each unit (access phase). Those learning objectives also formed the basis of the lectures' evaluation questionnaires, and were thus used for the curriculum evaluation (i.e., did we actually do thing things we intended to do?). Students responded to all topics on course evaluation questionnaires on five-point Likert scales; for the learning environment ratings were from 1, strongly agree to 5, strongly disagree, and for the overall rating of the imparted knowledge were from 1, excellent to 5, unsatisfactory.
Participants are qualified medical doctors or researchers of biomedical areas related to the field of oncology. Students are not selected by their level of experience, given that they come from all over the world where there are varying conditions in both medical research and education, thus the classes are heterogeneous in their experience in clinical research and especially medical biometry. The primary goal of the biometry course within the AO study programme was not to create experts in statistics, but rather to form skilled medical researchers that have the ability to knowledgably communicate with biometrical experts and to understand their own work from a medical and statistical point of view. Moreover, we would like to sensitize the AO students to the importance of applying appropriate statistical methods and interpreting study results carefully. For the evaluations presented in the following section, students' median age was 41 years (range 29-53 years) with a higher proportion of male students (68%). About 76% of students worked as a practicing physician in the field of oncology.
| Results|| |
Implementation of didactic videos and supportive material
Camtasia Studio software (Okemos, Michigan, USA) was used to build the videos. These verbally supported presentation slides are the primary media to impart information to the AO study programme learners. We created video lectures for the most important topics of medical biometry [Table 1]. Lectures were in English and used simple language because lecturers as well as students were predominantly not native English speakers.
Following the classical triad of the didactic process (access, work, closure), each video started with an introduction pointing out the key elements that would be discussed in that lecture (access). The principal part of each lecture contained the information to be learned using descriptive examples to convey theoretical concepts (work). Using examples that were familiar to the audience helped capture the learners' attention for new contents. Each video lecture closed with a short summary of the main take home messages (closure). Using a tablet monitor during the video recording enabled the lecturer to go interactively through the presentation slides for illustrative purposes.
To facilitate self-regulated and active learning, we created supplemental learning materials. Review articles were provided for all units to summarize the lectures' content. Appropriate exercises were prepared for most lectures to activate the learners. Students extensively used multiple choice questions that were prepared for each lecture to enable self-evaluation prior to the exam. Finally, the students were introduced to statistical software during the face-to-face seminars at the beginning of the course.
Implementation of tutorial measures
We provided several teaching-learning modalities for students to access course information: Audibly via didactic videos, visually via the presentation slides, in writing through the review articles and practically via exercises and multiple choice questions. Due to the physical separation of students and faculty, tutorials were web-based, through on-line forums, email and on-line conferences. With the second AO cohort, the faculty of the biometry course also participated in the in-person seminars before the on-line lectures to introduce themselves to the learners or after the lectures but before the exam to review the contents of the biometry course. Early contact with the students allows faculty to point out the importance of preparing for the exams well in advance. Recapitulating the lecture material before the exam in a flipped classroom approach has been shown to help students, giving them the opportunity to raise questions for points that had remained unclear during the term.
Self-evaluation of the implementation process
Implementing the videos and their supporting material was more time-consuming than the typical lecture preparation for conventional, in-person classes. Slides and further teaching material were available for most of the contents in German, but everything then had to be translated into English and carefully checked for linguistic accuracy.
Maintaining close contact with students proved challenging, as students did not attend the internet-based video conferences. Therefore, these are no longer offered. Students also seldom used the forums, but we continue to offer these. To be more visible to students, we became more active participants during the face-to-face seminars. We use the seminar just prior to the exam to raise questions and to review the more complex topics from the lectures. Practical examples are also addressed during this seminar. Students have provided positive feedback for this approach.
Student evaluation of the lectures
Students from the first three cohorts have evaluated the biometry course. We looked at evaluations provided by the students within two groups: There were 18 students in the initial cohort (Group A) and 23 students in the second and third cohorts combined (Group B); the latter group had participated after the first set of revisions to the course as described above. Averaged over all biometry lectures, evaluations of group B was higher than for Group A (mean = 1.59 [SD 0.22] vs 2.23 [SD 0.28]). There were no meaningful demographic differences between the groups to confound the comparison.
The evaluation for each lecture covered general questions concerning lecture-related learning objectives, technical support, expert support and an overall rating [Table 2]. The latter is most relevant as it provides the students' recommendation whether to continue, to refurbish or to discontinue a particular lecture. The range of mean evaluation values over all lectures was 1.6-3.0, that is, the majority agreed with the formulated statements. The main reasons for not using the provided applications and tutorial support were a lack of time and the fact that no further questions remained after working with the learning material.
The evaluation results for all lectures in the biometry course for the overall ratings of knowledge impartation are presented in [Figure 1], showing lower ratings for lectures with a more methodological content.
|Figure 1: Student evaluation in the biometry course for knowledge impartation (mean and standard deviation (in brackets) are given separately for the first AO cohort (group A) and the second and third AO cohorts (group B); dashed line with triangles: A evaluation; solid line with circles: B evaluation; sample sizes ranging from 5 to 22)|
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The learning environment changed modestly since the launch of the AO programme including cancellation of video conferences with a simultaneous enhancement of our presence during the attendance seminars and change of the examination regulations claiming now mandatory pre-exam assignments before entering the module examinations. The new examination regulations prevented some previously observed deferring and contributed to a better learning effect.
| Discussion|| |
The development and implementation of our online study programme was challenging and a very good experience for us personally as lecturers within the context of online learning. The main difference from our regular courses is that the AO programme is almost exclusively taught online with little opportunity for the lecturers to have personal contact with students. Students rated the learning experience generally positively, especially after we made some revisions.
We learned that some lectures require a genuine, face-to-face dialogue between lecturers and students to ensure they fully understand the theory and can apply it in practical examples. All technical devices used to create the lectures and to provide lecture support (tablet monitor, forums, self-examination exercises) contributed to programmes success. Students' evaluations of more complex course topics were lower, which could indicate the need for more descriptive examples.
It may be that online tutorials cannot fully replace face-to-face, direct interactions between lecturers and students. We addressed this by being more visible during the on-site seminars before and after the on-line portion of the course, which seemed to reduce students' inhibition about speaking up and raising questions. The course evaluation approach gave us important information to help guide modifications in the course structure.
In summary we conclude that e-learning of medical biometry is possible but is enhanced by supplementing on-line modalities with some face-to-face interactions of lecturers and students in a blended learning approach.
| Acknowledgement|| |
The Master Online Study Programme Advanced Oncology was funded from 2009 to 2012 by a fund from the Zukunftsoffensive III of the Federal State of Baden-Württemberg (grant number Az 34-802.67). The authors are particularly indebted to Stefanie Baertele, B.A., for her work in setting up the didactic evaluation questionnaires of this lecture series and for her helpful comments on the manuscript.
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[Table 1], [Table 2]
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