JMIR Publications

ABSTRACT

Background:

Electrocardiogram (ECG) interpretation is a core competence and can make significant difference to patient outcome. However, ECG interpretation is a complex skill to learn and research has showed that students often lack enough competence. Web-based learning has been shown to be effective when implemented as a primary mode of teaching or as a resource in a blended learning setting. Little is however known regarding why and how students use web-based learning when offered in a blended learning situation.

Objective:

Students’ use of web-based ECG learning resources has not previously been studied in relation to study strategies.

Methods:

A qualitative explanatory design using mixed methods was adopted to explore how medical students reason around their choice to use or not to use a web-based ECG learning resource. 15 of 33 undergraduate medical students attending a course in clinical medicine were interviewed. Data on usage of the resource were obtained via the learning management system for all students. At the final exam all students answered a questionnaire on study strategies, questions about Internet access and estimated own skills in ECG interpretation. Furthermore, study strategies, and use-patterns were correlated with results from an ECG Objective Structured Clinical Examination (OSCE) and a written course exam.

Results:

Two themes were central in the students reasoning about usage of web-based ECG: assessment of learning needs and to plan according to learning goals. Reasons for using the web-resource were to train skills and regarding it as a valuable complement to books and lectures. The main reasons for not using the resource were believing they already had good enough skills and lack of awareness of its availability. Usage data showed that 21 students (63%) used the web-resource. Of these 11 were “minimal-users”, and 10 “major-users” based on usage activity. Large variations were found in time spent in different functional parts of the resource. No differences were found between users and non-users regarding OSCE score, final exam score, self-estimate of knowledge or favouring self-regulated learning.

Conclusions:

To use or not to use a web-based ECG learning resource is largely based on self-regulated learning aspects. Decisions to use such a resource is based on multifactorial aspects such as experiences during clinical rotations, former study experiences and the perceived learning needs. The students’ own judgment of whether there was a need for a web-based resource to achieve the learning goals and to pass the examination was crucial for their decisions to use it or not. An increased understanding of students’ regulation of learning and awareness of variations in their ECG learning needs can contribute to improve course design of blended learning ECG contexts for medical students.