JMIR Publications

ABSTRACT

Background:

Learner autonomy is vital in voluntary online education, but its specific impact on learning outcomes, particularly in acquiring practical medical skills like cardiac auscultation, remains underexplored.

Objective:

This study aimed to quantify the role of learner autonomy in determining the effectiveness of voluntary online cardiac auscultation training.

Methods:

We conducted a prospective, self-controlled, single-center study, enrolling 122 doctors and 77 medical students through WeChat. Participants attended four 2-hour online interactive sessions using authentic heart sound recordings, supplemented by imaging modalities and clinical case studies. Learner autonomy was quantitatively assessed via pre- and post-training tests, frequency of responses to random in-class questions, and detailed tracking of post-class review activities. Data were analyzed using multivariate linear regression and receiver operating characteristic (ROC) curve analysis.

Results:

Of the 199 registrants, 73% participated, and only 23% completed all sessions. Auscultation test scores improved significantly from 40 (20-50) to 70 (50-83) (P=0.000). Full attendance (β=0.602, P=0.000) and active classroom engagement (β=0.695, P=0.000) significantly predicted higher final scores. Intrinsic motivation correlated positively with full attendance (P=0.045). ROC analysis demonstrated that outstanding learners engaged significantly more in post-class review activities.

Conclusions:

Learner autonomy—manifested as full participation, active engagement, and intrinsic motivation—is crucial for successful outcomes in voluntary online cardiac auscultation courses. Educators should strategically foster learner autonomy by clearly defining learner prerequisites, explicitly communicating course requirements during recruitment, integrating interactive and community-building elements into live sessions, and actively encouraging structured post-class review activities.