An E-Learning Approach to the Prevention of Venous Thromboembolism: An Educational and Human Factors Study

Abstract

The research contained within this thesis submitted for the degree of Doctor of Philosophy in Medicine investigates the role of e-learning in improving knowledge mastery around venous thromboemolism prophylaxis among medical students. Following an exhaustive literature review of venous thromboembolism epidemiology, pathology and prevention, educational theory, e-learning techniques and the delivery of education about venous thromoboembolism to medical students, the key deficiencies in our understanding of this disease were identified. We found multiple small cohort studies about the use of e-learning in medical education, but a paucity of randomised controlled trial data surrounding the use of e-learning platforms, and limited information regarding the role of instructional erongomics in e-learning delivery for medical education. Conducting a randomised controlled educational trial may determine the utility of elearning for improving student’s knowledge of venous thromboembolism prophylaxis. This investigation commenced with the development of e-learning modules in surgery, medicine, oncology, obstetrics & gynaecology and orthopaedic surgery. Two further assessment modules were also developed; one to measure baseline knowledge about venous thromboembolism prophylaxis, and one to measure postintervention effect. A randomised controlled trial was conducted to measure the effect of e-learning at improving knowledge of thromboprophyaxis guidelines. Students randomised to use the e-learning module did not demonstrate any improvement in knowledge surrounding VTE prophylaxis, either in comparison to the control group, or in comparison to their own baseline scores. Interestingly, however, students demonstrated a statistically significant improvement in knowledge when they were re-tested six months after finishing the e-learning program. This result may demonstrate that e-learning is a useful tool in a blended learning model of teaching, however, there is a possibility that confounding factors had played a role. We conducted a subgroup analysis to determine whether performance in certain cases within the e-learning module were predictive of final outcome, and whether time spent on each case was associated with final performance. We demonstrated that performance in the eMedici VTE Prophylaxis Module appeared to be associated with performance in areas of medicine in which students had prior experience, or were currently rotating. Finally, we were interested in examining ergononic factors related to the use of elearning material, particularly as one member of the group had published similar research examining the use of computer-aided learning when material was presented on CD-ROM. There is limited reporting on ergonomic data in the medical education literature, and we felt that this study may also help explore the possible causes of the results of the randomised controlled trial. This study demonstrated the importance of usability testing in designing online medical education resources, and suggests the importance of supporting online learning through the provision of physical learning spaces and infrastructure within the clinical setting.