Thursday, July 2, 2015

A constructivist approach to transesophageal echocardiography

Nanhi Mitter, MD, MEd
The Johns Hopkins University School of Medicine

Constructivism and multimedia learning theory (MMLT) have been established as formidable and effective methods of creating curricula for medical education; however, no such methodology has been applied to the approach of education involving transesophageal echocardiography (TEE). The purpose of this study is to develop a curriculum for TEE following the principles of curriculum design and employing constructivist based and MMLT educational strategies. Four workshops were created that incorporated constructivist and multimedia design principles that covered the topics: (1) Indications/Contraindications/Complications, (2) Image Orientation, (3) Regional Wall Motion, and (3) Global Left Ventricular Systolic Function. The five fellows in an ACGME-accredited cardiothoracic anesthesiology fellowship program at Johns Hopkins Hospital were enrolled in this study and participated in a pretest in July at the beginning of fellowship, followed by involvement in four interactive constructivist based workshops and then completed two posttests – one in August immediately following the workshops and again in December, four months after the workshops. After the study was completed, the data from the December posttests was lost.

The study team found the incorporation of constructivist based methodology to be both feasible and practical and the fellows found this experience to be enjoyable, findings consistent with other studies. The most improvement across examinees was seen in the area of image orientation followed by indications/contraindications/complications, regional wall motion and global left ventricular function. Given the low sample size, the reliability of the July pretest and the August posttest was -1.13 and 0.07, respectively. After both item and test level analysis, the reliability of both July and August tests could be improved to 0.80 by deletion of specific questions. In this study with a small sample size, the results are challenging to extrapolate however; this study can set the stage for future studies that incorporate constructivism and MMLT in TEE and other areas of graduate medical education.