E-ISSN : 2757-7163
Materials and Methods: In our urology clinic, the training success scores of seven randomly selected training groups, who were trained with the traditional model between 1998-2018, and the 4th year medical students who were trained with the hybrid model between 2018-2020 and constituted five randomly selected training groups were compared. Of the total 582 medical students, included in the study, 278 (47.8%) were enrolled in the traditional model group, and 304 (52.2%) in the hybrid model group. The training was evaluated with hands-on applications and theoretical and oral exams. Differences between both male and female students and differences that may vary depending on different faculty members teaching the students were evaluated using multivariate logistic regression analysis.
Results: The training success rates were significantly higher in the hybrid model group (300/304; 98.7%) than in the traditional model group (261/278; 93.9%) [p:0.002]. Multivariate logistic regression analysis found that factors such as the number of training groups, gender of medical students, and evaluations of different faculty members did not affect the educational success rate.
Conclusion: The hybrid model could be accepted as a mobile education model in a sense. The exam results of medical students educated with the hybrid model were better than those receiviing training with the traditional model which can be explained by the increased accessibility of medical students to education in the hybrid model without constraints of time and place. Additionally, it is thought that conducting the oral exam as a "structured oral exam" also contributed to these results.
Traditional medicine education continues to be the cornerstone of many educational institutions in the world. In addition to traditional education, the use of mobile devices will be essential for the education and exams of medical students, interns, and medical residents [3-5]. There is limited information in the literature about the place of hybrid models in urology. In this study, we have compared training success rates between traditional and hybrid model of education among 4th-year medical students rotating in urology clinics of a university hospital.
The total duration of teaching in urology for 4th-year medical students was 3 weeks. In either group, the theoretical lessons were presented by seven academic members during training period. Practical activity report cards were given to the students at the start of training which they filled out with practical activities they carried out such as patient examinations, urethral catheterization, minor surgical intervention, etc. The two groups had the same practical and theoretical objectives. The students that had ≥60/100 grades on their report cards were considered successful at the practical exam at the end of training and gained the right to sit for the theoretical exam. Unsuccessful students were excluded from the training program.
In either group, the theoretical exam consisted of two parts; a test exam and an oral exam (traditional or hybrid). The test exam was organized as a multiple-choice test. The overall theoretical grade was calculated by the arithmetic mean of the test and oral exam grades.
In the hybrid group, the hybrid oral exam was applied with the help of software developed by our clinic using Microsoft Access. The questions, asked in an oral exam by an academic member, were randomly chosen among question groups at Urology Training Applications that also had the answers to them.
In either group, theoretical oral exams were done by seven academic members for seven student groups. The students were examined again by a different academic member in case they failed the oral exam, and then the theoretical oral exam grades were estimated, and expressed as the arithmetic mean of the final grades assigned by both academic members. The medical students who had both practical and theoretical exam grades of ≥60 were evaluated as successful. The final grade was estimated, and expressed as the arithmetic mean of the practical and theoretical exam grades. The students who scored less than 60 in the practical exam weren"t allowed to enter the theoretical exam and had to repeat the internship. However, students who scored less than 60 on the theoretical exam were given a chance to resit the exam. If they failed to surpass 60 points after the resit exam, they had to repeat the internship as well. The study protocol was reviewed and approved by the Mersin University Clinical Research Ethics Committee (04.26.2023/294).
Statistical Analysis
Descriptive statistics for continuous variables were expressed
and also tabulated as mean ± standard deviation, and for categorical
variables as frequencies, and percentages (%). T-test were used to
compare continuous variables between the two groups. One-way
ANOVA and post- hoc tests were used to compare continuous
variables among the groups, and chi-square test was used for
qualitative variables in patient groups. In addition, multivariate
logistic regression analysis was done to present factors predicting
training success. Statistical analysis was performed using Statistical
Package for the Social Sciences software (version 21.0, IBM SPSS),
and a p-value of less than 0.05 was considered statistically significant.
Table 1: Comparisons of the mean grades for all items of exam in education model groups
Table 2: Comparisons of the mean grades for all items of exam in education&gender groups
Figure 1: Mean grades by education model and gender
Multivariate logistic regression analysis was done to present factors predicting training success among the students. The number of training groups, gender of the medical students and evaluation by a different academic member have predicted the training success in both groups (p>0.05 and p>0.05, respectively). Based on results of the one-way ANOVA test, the mean training grades evaluated by different academic members were not significantly different in the hybrid model (p:0.072), but they differred significantly in the traditional model (p:0.004).
Although traditional medical education is the cornerstone, the development of new methods such as mobile messaging attracts the attention of educators [6]. Especially during the COVID-19 pandemic, medical education had to be carried out virtually in many countries of the world. Indeed, Pandya et al. have shown that the use of these easily accessible applications can improve nephrology education [1]. Various studies have examined the use of instant messaging applications in medical education and have shown that students" learning motivation and satisfaction increase depending on these applications [7,8]. In studies evaluating online and offline education in dermatology, it has been suggested that online teaching presents some difficulties [9,10]. Recently, Shahar et al. evaluated the role of secure instant messaging applications, and Siilo which is also a secure instant messaging application in medical education [11]. They demonstrated that the "Siilo" appeared to be a promising tool for facilitating case-based learning in a medical setting and it was found to be user-friendly and secure, with a high level of satisfaction reported by participants.
To the best of our knowledge, these two educational models for medical students rotating in urology have not been compared so far. In our study, the mean success grades for all items of the exam were significantly higher in the hybrid education model compared to the traditional education (Table 1). A remarkable amount of increase was observed in success rates of both male and female students in the hybrid group, compared to the traditional model. Female medical students in both groups were more successful than their male counterparts (Table 2, Figure 1). In multivariate logistic regression analysis, the sample size of the training group, students" gender, and evaluation by different academic members did not predict the training success in either group. However, based on the one-way ANOVA test results, the mean training grades given by academic members were not significantly different in the hybrid model (p:0.072) but differed significantly in the traditional model (p:0.004). We have attributed this issue to the standardization of questions and answers in the structured oral exams.
This study has several limitations. First of all, it was done only in our own center. Second, different applications were not compared in our study. On the other hand, the strength of our study is that it will shed light on future multicenter studies performed with a larger sample size in the field of urology education.
Ethics Committee Approval: The study protocol was reviewed and approved by the Mersin University Clinical Research Ethics Committee (ethics committee approval date and number: 26.04.2023/294).
Informed Consent: An informed consent was obtained from all the patients.
Publication: The results of the study were not published in full or in part in form of abstracts.
Peer-review: Externally peer-reviewed.
Authorship Contributions: Any contribution was not made by any individual not listed as an author. Concept – E.A., E.E.; Design – E.A., E.E.; Supervision – S.C., M.B., E.U.; Resources – H.E.D., M.T.; Materials – H.E.D., M.T.; Data Collection and/or Processing – E.U., H.E.D., M.T.; Analysis and/or Interpretation – E.U., H.E.D., M.T.; Literature Search – H.E.D., M.T.; Writing Manuscript – E.A., E.E.; Critical Review – E.A., E.E., S.C.
Conflict of Interest: The authors declare that they have no conflicts of interest.
Financial Disclosure: The authors state that they have not received any funding.
Supplementary Materials
1. Urology Internship- Mobile Application (Google Play)
https://play.google.com/store/apps/details?id=com.akbay.
erdem.urologytraining&gl=TR
2. Mobile Urology Internship & Internship Exam Guide (App Store) http://www.mersinuroloji.com/?smd_process_ download=1&download_id=542
3. Urology False-True Hybrid Quiz (Google Play) https://play.google.com/store/apps/details?id=com.akbay. erdem.urologyhibridquiz
4. Urology Multiple Choice Quiz (Google Play) https://play.google.com/store/apps/details?id=com.akbay. erdem.multiplechoice
5. Mersin Urology Structured Oral Exam http://mersinuroloji.com
6. Mersin University Urology Training Videos https://www.youtube.com/channel/UCWfDer4I9WG_ Gr4Fu3Gnwxw
1) Pandya A, Elrggal ME, Jhaveri KD. Use of Semiprivate
Smartphone Communication Applications in Nephrology
Education. Semin Nephrol. 2020;40(3):303- 8.
https://doi.org/10.1016/j.semnephrol.2020.04.010
2) Thomas K. Wanted: a WhatsApp alternative for clinicians.
BMJ. 2018;360:k622.
https://pubmed.ncbi.nlm.nih.gov/29440047
3) Shaw CM, Tan SA. Integration of mobile technology in
educational materials improves participation: creation of
a novel smartphone application for resident education. J
Surg Educ. 2015;72(4):670-3.
https://doi.org/10.1016/j.jsurg.2015.01.015
4) Pyörälä E, Mäenpää S, Heinonen L, Folger D, Masalin T,
Hervonen H. The art of grade taking with mobile devices
in medical education. BMC Med Educ. 2019;19(1):96.
https://doi.org/10.1186/s12909-019-1529-7
5) Lau C, Kolli V. App Use in Psychiatric Education: A Medical
Student Survey. Acad Psychiatry. 2017;41(1):68-70.
https://doi.org/10.1007/s40596-016-0630-z
6) Walsh K. Mobile Learning in Medical Education: Review.
Ethiop J Health Sci. 2015;25(4):363-6.
https://doi.org/10.4314/ejhs.v25i4.10
7) Zulfikar I, Zaheer F, Baloch Q, Ahmed F. The new face of
learning: social media innovating medical education. Int J
Educ Psych Res. 2018;4(1):1-5.
https://doi.org/10.4103/jepr.jepr_73_16
8) Dyavarishetty PV, Patil DC. An interventional study to
assess the effectiveness of "WhatsApp" as a teaching
learning tool in community medicine. Int J Community
Med Public Health. 2017;4(7):2564-9.
https://doi.org/10.18203/2394-6040.ijcmph20172860
9) Bari A. Dermatology residency training in COVID-19
pandemic: transition from traditional to online teaching. J
Coll Physicians Surg Pak. 2020;30(6):63-6.
https://doi.org/10.29271/jcpsp.2020.Supp1.S63
){kind=link}
){kind=link}
){kind=link}