https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/362 Fri, 29 Jan 2021 03:00:56 +0000 Abstract Background and objectives: The coronavirus disease 2019 (COVID-19) pandemic has necessitated the switch to distance education by abandoning face-to-face education worldwide. This study aimed to investigate whether it is possible for practical education and performance measurements through distance education. Methods: The application video and the application steps were sent to the participants through their smartphone by WhatsApp messenger. Grade 1 students in the Physiotherapy Section (Group A) and Grade 1 students in the Paramedic Section (Group B) voluntarily participated in the study. The participants were asked to apply simulation applications and record the simulation applications' video clips with their smartphones. Results: The mean age of the 123 participants was 20.11 ± 2.03 (18-33) years, and 56 (45.5%) were in Group A, and 67 (54.5%) were in Group B. While the participants in Group A were successful at a rate of 35.7% (n = 20) in the head tilt-chin lift maneuver, this rate was 65.7% (n = 44) for Group B (p = 0.001). For the jaw thrust maneuver, the success rate was 21.4% (n = 12) for Group A and 31.3% (n = 21) for Group B. Conclusion: In this study, the participants used family members as a live simulation model in our research. The participants who were given face-to-face education before were more successful on head tilt chin lift maneuver. Jaw thrust maneuver was more challenging to learn and practice by distance education. The academicians interested in medical education should keep in mind that the outcomes of the COVID-19 pandemic have permanent effects on education systems. IMC J Med Sci 2021; 15(1): 001. DOI: https://doi.org/10.3329/imcjms.v15i1.54195 *Correspondence: Mustafa Boğan, Emergency Department, Health Research and Application Hospital, Düzce University, Düzce, Turkey, Posta code: 81620.  Email: mustafabogan@hotmail.com   Introduction The coronavirus disease 2019 (COVID-19) pandemic has necessitated the switch to distance education through abandoning face-to-face education worldwide [1-2]. Distance education models have been used in medical education during the recent 30 years; distance practical education is still a problem [3-7]. On the other hand, useful and reliable methods could not be developed to evaluate distance education efficiency [7]. Basic Life Support (BLS) is among the most common practical education by using technological items [8-10]. In didactic medical education models, airway maneuvers are taught on models by an experienced instructor, in addition to theoretical educations [11]. Practical education is the main difficulty of distance education systems.In this study, we aimed to teach the airway maneuvers [the head tilt-chin lift (HTCL) maneuver and the jaw thrust (JT) maneuver] by distance education, and to evaluate by video clips which content practical application of the participants on a family member. It was also aimed at integrated simulation education to distance education in accordance with the education needs that have changed abruptly during the COVID-19 pandemic.   Methods Table-1: Global Quality score   The application steps were scored separately (Table-2 and Table-3). While evaluating the videos, each application step was scored as "1 point" if it was done correctly and "0 points" if it was not done correctly. Both applications were evaluated in 8 sub-steps. Each participant received a minimum of "0" and a maximum of "8" points from the applications. The participant who got eight full points from an application was considered successful; the participant who got < 8 points was unsuccessful. The videos were scored separately by two independent observers (two emergency medicine specialists with a minimum of 5 years of experience) using a rubric. Pearson Correlation test was used to determine rater reliability, which shows consistency between raters. Analysis results showed a high correlation between raters (r = 0.90; p < 0.05). The two groups were compared according to gender, duration of the videos, HTCL and JT score, success level of HTCL and JT.   Table-2: Head tilt chin lift assessment steps   Table-3: Jaw thrust assessment steps     Statistical Analysis The normality distribution of the data was evaluated with the Shapiro Wilk test. The Student’s t test was used for comparison of two independent normally distributed groups and the Mann Whitney U test was used for comparison of two independent non-normally distributed groups. The associations between categorical variables were analyzed with the Pearson and exact chi-square tests.Pearson Correlation test was used to determine rater reliability, which shows consistency between raters. For the descriptive statistics, the mean ± standard deviation was used for the numerical variables, and numbers and percentages were used for the categorical variables. Statistical analyses were carried out using the SPSS Windows version 24.0 package program and a p level of < 0.05 was accepted as statistically significant.   Results     Discussion Studies have reported that some methodological innovations are required for to develop the students’ knowledge and skills in distance education environments [13-17]. The studies toward developing novel education paradigms are mostly based on comparison of didactic education systems and distance education systems. Gallagher et al. determined that students who received web-based distance education demonstrated better attendance and motivation [18]. In the study of Sarıhan et al. comparing two emergency medicine resident groups who had received traditional and video-assisted education, no significant difference was found between the groups concerning pre-test and post-test scores [19]. Bernard et al. evaluated the studies investigating learning methods between 1985 and 2002 and found that distance education models achieved better learning [20]. However, some education models, which use both didactic education systems and distance education systems, are also available [21,22]. Our study compares distance education procedures (Group A) and blended education procedures (Group B). In our research, while there was no difference between the groups about the JT maneuver, Group B, the complex education group, yielded better results for the HTCL maneuver. In this regard, our study results are consistent with those of studies proposing that complex education systems that integrate didactic learning models and distance education systems positively influence learning [22,23]. One of the most critical distance education problems is feedback and testing of lesson elements [7,24]. Assessments of the performance were mostly made with traditional methods in many studies comparing e-education models and traditional education models. Our study, the participants recorded their applications on videos through cell phones, and their learning performances were evaluated through these videos. Hence, we could show that a performance assessment criterion could be developed for distance education by assessing videos recorded by the participants. It is possible to state that although simple, this is a methodological innovation type under pandemic conditions, and it is one of the unique aspects of our study. On the other hand, this was mandatory for us under pandemic conditions despite limited evidence about the effectiveness of offline video applications on e-learning [25]. However, it should be stated that the duration of the application videos recorded by the researchers and participants were shorter than the 5-7 min reported in the literature [24]. Barsuk et al. showed that the medical student group which received practical education through a simulator was more successful in airway management [30]. Birt et al. did not detect a difference between the two groups of paramedic students, one of which received a classical education for removing foreign bodies in the airway and another received distance education with telephone and plastic laryngoscopes obtained with a 3D printer [31]. In our study, which yielded practice training through live models, the finding of similar results in the two groups about the JT maneuver is consistent with the studies that have proposed that learning through e-education only is an effective way of learning [32]. The participants in both groups mostly made errors in the 6th step of the JT maneuver. This is the step that is frequently taken incorrectly by the participants, also during face-to-face training. The subject should repeat the procedure several times; besides, he/she needs to be instructed individually. Studies propose that formal assessment systems are insufficient in medical education [33]. We suggest that it is an advantageous method in hands-on training as it is possible to monitor learning, provide feedback to the student, and provide assessment data for the teacher. Studies are proposing that online lessons of the formal assessment methods are also possible [33-35]. We could not apply formal methods individually online due to the pandemic’s restricted time. We suggest that this is a factor that plays a role in the low (< 30%) success rates in both groups. Due to the restricted time, the steps that were misapplied by the participants could only be discussed with them individually online. Not asking for a second video after the application has led to a limitation concerning performance assessment. Furthermore, the satisfaction of the participants could not be evaluated. The academicians interested in medical education should keep in mind that the outcomes of the COVID-19 pandemic have permanent effects on education systems. The COVID-19 pandemic has necessitated the development of a novel education paradigm based on information technologies. The need for integration of simulation education with distance education has also emerged during this process. Although our study indicates that distance hands-on training may be practical, it is also an example of assessing this education. We consider that virtual reality applications could contribute to medical education, and further studies should be conducted on this issue. References 1.     Srinivasan DK. Medical students’ perceptions and an anatomy teacher's personal experience using an e‐learning platform for tutorials during the Covid‐19 crisis. Anat Sci Edu. 2020; 13(3): 318–319. 2026 Ibrahim Medical College. All rights reserved.