Thursday, 2 May 2013

Online module on acute medicine for Monash MBBS Year 5 students

Academic rationale

In Year 5 Monash MBBS curriculum, students spend the whole academic year functioning as pre-interns. The main focus of the final academic year is to ensure work-preparedness for their impending internship by producing students who are able to function comfortably in a clinical environment.

Removing students from the wards for classroom activities will not be in keeping with such objectives. Furthermore, at this stage of their development, students have different knowledge gaps and as such having them sit together for hours, to go through the same content for all, makes little sense. Students need to acquire the habits of the self-directed learner and must actively seek to identify knowledge gaps, which is a necessary prerequisite before any actions can be undertaken to fill that gap.

An online module will help to facilitate self-directed learning, while allowing us to deliver formal content without removing students from the clinical environment. It is in keeping with the faculty’s move to increase online learning opportunities and is cost-effective in terms of time and resources. With online modules, it is possible for a small number of tutors to facilitate virtually an unlimited number of learners.

We are aware that rote learning of responses is difficult to justify in many clinical circumstances. There is however at least one exception; in the setting of junior doctors acting as first responders in the management of acute situations. The objective of this module is therefore manifold; to invite students into an active learning activity where they are tested in their knowledge of management of acute emergencies, to highlight knowledge gaps, to provide links and references so that students can immediately access materials for further reading, to introduce credible sources of information which students may continue to access in the future and finally to help them rote learn some of these responses in preparation for their impending internship. 

Why final year students?

The rationale for introducing the module at this stage of their professional development are many:

  1. Students at this stage, due to their impending internship and insights they have gained from spending time in the clinical environment often perceive that their knowledge on management of acute emergencies as lacking
  2. The above impression is further compounded by their realisation during clinical attachment or simulation activities that management of the deteriorating patient is drastically different from that of stable patients. Acute emergencies often involves immediate application of readily learnt responses. 
  3. Students at this stage realise that they need to have a working knowledge in managing the acutely ill. Looking up information for the first time, on the spot, is not easy if you're under pressure!


  1. To provide an active learning activity where students are tested in correct management of acute emergencies.
  2. To provide links and references that students can immediately access for further reading
  3. To introduce credible sources of information e.g. websites which students may continue to access in the future 
  4. To evaluate the usefulness of this module as perceived by students 

Proposed format of the online module

This module on acute medicine will be introduced through Moodle as a pilot project targeting final year Monash MBBS students from the Malaysian cohort.

The following is an account of actions completed for the project:

  •  Individuals who are content experts were invited to contribute questions on acute medicine across disciplines:obstetrics and gynaecology, surgery, medicine, critical care, paediatrics and psychiatry.These questions will be on management of acute emergencies and will include references, links and write-ups to accompany the answers.
  • School support was obtained to formally engage Monash Information Technology (IT) team.
  • Malaysian Monash IT team advised us on various software options available namely Google Forms, Survey Monkey and Moodle. The need for funding was also addressed and options which were available if this proved to be an issue were identified. After the consultation, we decided that it was best to use Moodle as other options would involve external funding. Moodle was already funded by Monash and this project is in keeping with the faculty’s move to increase online learning content, hence our confidence that it will be supported.
  • Monash University Australia IT team was contacted to explore the possibility of utilizing Moodle for the pilot project. It was clearly explained that if this project is successful, the plan is for the quiz to be made available to all Monash students.
  • MUA IT team subsequently directly assisted us in finalising the online format.
  • We have now finalized the format of the questions and are at final stages of implementation.

The following are the finalized format of the online module which is in the form of a formative online quiz:

Format: MCQ

Other formatting requirements:
  • Students will need to log in
  • For each question, students are asked to select the correct options (multiple selections possible). At the end of each question students will click on a 'submit' button and the correct answers will be displayed immediately, along with references in the form of citations or a write-up on the topic which was prepared by an academic. For some questions, there may be a link that will direct students to a full reference.
  • After students have finished the whole series of question, they then click to 'submit' the whole paper to obtain a score.
  • Before a score is displayed, students will be invited to fill up a very short evaluation form. 
  • Students can attempt an unlimited number of tries - the aim is for students to eventually get 100% which hopefully means learning of the correct management options.
  • As students need to log in every time the quiz is accessed, their performance can be tracked over time.

Anticipated activities for implementation and evaluation
The following are our immediate plans and timelines for implementation, starting from the 2nd of May, 2013:
  • Three weeks to finalise a list of 20 to 30 questions complete with references and design an evaluation form. The evaluation form will assess the quality of questions as well as the perceived relevance/usefulness to pre-interns. It will include opportunities to provide free text comments.
  • Two weeks for MUA IT staff to format the quiz and set it up on Moodle for a trial period
  • One week of trial period – during which we will attempt the quiz ourselves to detect any problems with either the format, access, references or evaluation.
  • One week following the trial period for any adjustments of the above if necessary.
  • Two week period during which the quiz will be opened to students. The pros and cons of allowing only a specific period of access were discussed. In the end it was decided that a limited duration of access will be more likely to invite participants then leaving the quiz open indefinitely. The latter would also mean that we will need to send frequent reminders/invitations to students to access the module which will complicate matters and contribute little extra to this project which is at the pilot stage.
  • After the quiz is closed, a further 4 to 6 weeks to analyse the results and write up a report.
  • During this period, an email will be sent to all students in Year 5, to invite further feedback on the quiz including that of any specific questions or references that were of poor quality.
The initial planned format of the quiz was to include a link to an evaluation form at the end of each question which is voluntary and will allow students to grade the quality of each question as well as to provide free commentary which the moderator will then look into - this particular evaluation is strictly voluntary and will not prevent them from proceeding to the next question. However after discussions with Marissa, this will add significant complexity to the formatting of the quiz and so it was decided that we will not incorporate this at this stage.

Examples of contents to be included:

  • Advanced life support algorihtm for all life threatening arrhythmias
  • Life threatening electrolyte imbalances
  • Advanced trauma life support
  • Management of shock states
  • Obstetric emergencies
  • Psychiatric emergencies
  • Paediatric emergencies
  • Airway crises for first responders

Research potential:
There are a few potential areas for research with the introduction of this module:
  • What are students' perceived level of confidence with managing acute emergencies?
  • How useful are the questions, references and links as perceived by the students?
  • What was the rate of response considering that this is a strictly voluntary formative exercise?
  • What was the average student performance at the first attempt?
  • How many attempts before students achieve 100% correct answers?
  • Does repeated exposure result in better performance?
  • To what degree does this module help in improving level of confidence in managing acute care?
Proposed future development:
  • Repeated exposure for students over the course of clinical years. The module could be offered at regular intervals with similar questions designed to test principles of management of an acutely ill patient.
  • A multi-pronged approach to improve competence in managing the acutely ill which will include not only this online quiz but other components such as small group case-based learning and simulation.

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