Problem-based learning-standardized preoperative conversation improves neurosurgery residents' understanding of cerebellopontine angle tumors

doi:10.21203/rs.3.rs-4816867/v1

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Research Article

Problem-based learning-standardized preoperative conversation improves neurosurgery residents' understanding of cerebellopontine angle tumors

https://doi.org/10.21203/rs.3.rs-4816867/v1

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Objectives

This study aims to explore the effects of problem-based learning (PBL) and Prescription-based preoperative talk (PPT) teaching methods in the teaching of tumors in cerebellopontine angle (CPA) of clinical neurosurgery residents.

Methods

130 neurosurgery residents in Qilu Hospital of Shandong University were randomly divided into two groups. The experimental group adopted the combination of problem-based learning (PBL) and Prescription-based preoperative talk (PPT), referred to as PPP. In contrast, the control group simply learned the material on their own. The effectiveness of the teaching methods was then assessed using theory test scores and customized questionnaires.

Results

Compared with the control group, the test scores of the experimental group were significantly improved (P = 0.005). In addition, the test score of the experimental group was still higher than that of the control group one month after course (P = 0.033). The satisfaction questionnaire of PPP teaching method showed that the experimental group had higher satisfaction in 6 aspects of stimulating an interest, enhancing students’ self-learning abilities, mastery of basic and anatomical knowledge, analytical and problem-solving skills, help for clinical thinking, doctor-patient communication skills.

Conclusion

In the teaching of cerebellopontine angle tumors, the PPP teaching method can provide a unique experiential learning opportunity for neurosurgery residents, improve theoretical test scores, and promote self-evaluation and satisfaction. In addition, this method can enhance neurosurgical residents' understanding of tumor diseases in CPA region. Therefore, it helps to improve the overall teaching effectiveness.

PPP teaching

PPT teaching

PBL teaching

CPA tumor

Clinical teaching

Preoperative talk is an indispensable and important part of preoperative preparation in hospital [1]. Through face-to-face communication with patients and their families, doctors can more comprehensively understand the patient's condition, know the patient's clinical symptoms, browse the patient's image data, identify the disease, make a disease diagnosis, make a treatment plan, and make a scientific decision for surgery [2]. Secondly, doctors should explain the purpose, process, risks and precautions of the operation in detail to patients and their families, so that patients and their families have full understanding and confidence in the operation [3]. In addition, doctors need to answer the questions of patients. Patients and their families may have some questions and concerns about the operation, and doctors should patiently answer them to eliminate the concerns of patients and their families and enhance the confidence of patients and their families. Then, through preoperative conversation, doctors can establish a good communication relationship with patients and their families, enhance the patients' and their families' trust in doctors, and improve patients' satisfaction [4]. Therefore, the importance of normative preoperative talk is self-evident. An effective preoperative talk can not only enhance doctors' understanding of disease and surgery, but also establish patients' and their families' cognition of disease and surgery, and establish a good doctor-patient relationship.

Problem-Based Learning (PBL), an instructional paradigm in which learners are grouped under the guidance of a non-instructional tutor and take on tasks with real-world or complex challenges that reflect situations involving real problems and experiences [5, 6]. As a learner-centered, interactive teaching method, PBL encourages students to delve deeper into these issues through self-study, research, discussion, and collaboration in their respective groups. PBL combines theory with practice and applies knowledge and skills to develop actionable solutions to specific problems [7]. Thus, compared to traditional learning methods, PBL fosters independent problem solving, promotes self-education, and fosters sustainable learning [8]. PBL has now proven to be an important tool in medical school curricula.

Residents often just graduate from school and start their jobs. They are in the transition period from theoretical knowledge learning to clinical practice [9], and their professional knowledge system is not perfect and professional skills are not up to standard [10]. When they need to explain the condition to patients and their families, explain the treatment plan, and analyze the pros and cons of different treatment plans, they cannot make detailed and accurate descriptions and handle the condition inappropriately, which greatly reduces the trust of patients and their families in them and even arouses the emotions of patients and their families, leading to medical disputes. Therefore, the professional knowledge and skills of residents need to be improved, and the communication ability between doctors and patients needs to be improved.

We combined problem-based learning with a prescriptive preoperative talk to evaluate the effectiveness of this composite teaching approach for neurosurgery residents, which we refer to here as PPP (PBL and PPT), particularly in the application of tumors in the CPA area of neurosurgery such as acoustic schwannomas, one of the most common CPA space occupying lesions [11, 12].

Participants

We prospectively recruited 130 residents working in the Department of Neurosurgery at Qilu Hospital of Shandong University from September 2021 to June 2024. One hundred and thirty residents spent one month in neurosurgery and were divided into two groups on the first day of neurosurgery. Participants were randomly divided into a "PPP group" with PBL combined with PPT teaching method and a "control group" with self-study without arrangement. Residents don't know their group assignments until they practice. Simple randomization method was used in this study [5]. All residents are renumbered 1 to N [5]. If the assigned number is an odd number, it enters the PPP group. If the assigned number is an even number, it enters the control group. During these three years, 65 residents were assigned to the PPP group and another 65 were assigned to the control group.

Study design

We selected acoustic neuromas located in the cerebellopontine angle region as the research subjects, because the clinical manifestations, diagnosis and treatment of acoustic neuromas are one of the diseases that neurosurgery residents must master. In addition, the anatomical location of such diseases is relatively fixed, and there are more cranial nerves and blood vessels involved around the lesions, resulting in a high proportion of postoperative neurological dysfunction [13, 14]. We combined PBL and PPT for research, and the research design flow chart is shown in Fig. 1.

PPP group

On the first day of neurosurgery, a 20-question pre-course test is taken. The instructor then gave the resident a general guide to the treatment of acoustic schwannomas (in both Chinese and English), six disease-related references, and each resident was asked to study these materials in his/her own spare time. In addition to daily clinical work, the teacher required residents to conduct normative preoperative talks with patients and their families in accordance with normative preoperative talk procedures. The normative procedure of preoperative interview is shown in Fig. 2. After the conversation, the teacher first supplemented the content of the conversation, and then the residents held group discussions under the guidance of the teacher. During these discussions, residents were encouraged to ask relevant questions and seek answers on the Internet and library databases. Then, a resident representative from each group gave a presentation, reviewing the key points of this preoperative conversation, sharing answers to questions raised by their group, and discussing unresolved issues. Finally, the teacher summarized and reviewed the difficult issues raised during the discussion. After one month of study, a 20-question post-course test is given. One month after leaving neurosurgery, the 20-question test was repeated to measure knowledge retention.

Control group

On the first day of neurosurgery, a 20-question pre-course test is taken. Residents are required to study the same CPA guidelines for the diagnosis and treatment of acoustic neuromas (in both Chinese and English) and references. Compared with the PPP group, the control group did not participate in the preoperative talk, which was completed by the teacher alone, but the residents in the control group performed the same clinical work. After one month of study, a 20-question post-course test is given. One month after leaving neurosurgery, the 20-question test was repeated to measure knowledge retention.

Assessment tools

Teaching effectiveness was assessed using a 20-question first-day and last-day test, a post-teaching examination after 1 month, and a questionnaire containing 6 self-evaluation items.

Theoretical assessment

For each group, before and after teaching, residents were asked to complete a 20-question quiz. All questions are based on Bloom's Taxonomy [15]. Pre-course quizzes are the basics. Post-course tests include basics and case studies. The questions for the two tests are different, but they are the same for each group. All residents take an exam to test their knowledge retention after 1 month of instruction. The main examination content includes basic knowledge and case analysis, covering all aspects of acoustic schwannoma in CPA area involved in this teaching. The question type is single choice. Each question is 1 point, and the total score is 20.

Satisfaction evaluation

After the teaching, residents in PPP group completed the project satisfaction questionnaire. The questionnaire includes Stimulating an interest, Enhancing students' self-learning abilities, Mastery of basic and anatomical knowledge, Analytical and problem-solving skills, Help for clinical thinking, Doctor-patient communication skills. Residents rated their satisfaction with different programs on four levels: very satisfied, satisfied, neutral, and dissatisfied.

Statistical analysis

Statistical analysis was performed by IBM SPSS Stactics 25 software. Measurement data is represented by x̅ ± SD. Independent sample t test was used for quantitative data. P < 0.05 was considered statistically significant.

The scores of the PPP group and the control group were compared

As shown in Table 1, we compared the scores of the PPP group and the control group in pre - and after-class tests and the test scores one month after teaching. The average pre-class test scores of PPP group and control group were 16.83 ± 1.93 and 16.98 ± 1.90, respectively, and there was no significant difference between the two groups (P = 0.648). At the end of the course, the average scores of the PPP group and the control group were 17.91 ± 1.17 and 17.23 ± 1.51, respectively. T-test showed that the score difference between the two groups was statistically significant (P = 0.005), and the score of the PPP group was significantly higher than that of the control group. PPP group and control group averaged 17.51 ± 1.08 and 17.05 ± 1.35 respectively on the tests conducted 1 month after teaching. T-test showed that there was a statistically significant difference in test scores between the two groups after 1 month (P = 0.033), and the PPP group was better than the control group in knowledge retention.

PPP group teaching satisfaction questionnaire

At the end of the course, PPP group students were surveyed to assess self-evaluation and satisfaction. The results showed that this group all had higher levels of satisfaction with Stimulating an interest, Enhancing students’self-learning abilities, Mastery of basic and anatomical knowledge, Analytical and problem-solving skills, Help for clinical thinking, Doctor-patient communication skills (Table 2).

In this study, the combination of normative preoperative talk and PBL was applied to tumor teaching in CPA area to investigate its teaching effect. Previous research has shown that PBL differs from traditional teaching methods, highlighting the advantages of promoting students' active self-directed learning [16]. In view of the lack of professional knowledge and technology, and the lack of doctor-patient communication ability of residents just entering the clinic [10]; The complex anatomical structure of CPA region [12] requires a solid foundation of anatomical knowledge, as well as strong spatial understanding and thinking ability to construct its spatial representation. The normative preoperative talk can strengthen the understanding of the anatomy, diagnosis and treatment of the disease, and improve the doctor-patient communication ability [17]. All residents were given three theoretical assessments, consisting of quizzes before and after class, and a major exam in the month after instruction (Table 1). Our results showed that the PPP group performed better than the control group in both the after-school test and the test 1 month later, indicating the effectiveness of the PPP approach in improving the theoretical test scores of oncology teaching in the CPA area. The results of the questionnaire survey show that students in the PPP teaching group have higher satisfaction in stimulating an interest, enhancing students’self-learning abilities, mastery of basic and anatomical knowledge, analytical and problem-solving skills, help for clinical thinking, doctor-patient communication skills (Table 2). These results suggest that PPP teaching methods improve residents' understanding of CPA tumors. PPP teaching method can bring students a more satisfactory independent learning experience, thus improving the teaching effect. In the pre-interview test, we saw no statistically significant difference between the two groups in their knowledge of the basics of the disease (Table 1). This may be due to the fact that they have accumulated enough basic knowledge through traditional classroom teaching during their undergraduate years. Considering that clinical medicine students are outstanding high school graduates, they have a strong understanding of basic knowledge through traditional classroom teaching. However, when the standardized preoperative talk was brought into the learning process of the disease, it was found that the PPP group had a firmer grasp of knowledge and a better knowledge structure in the test after 1 month.

This study suggests that PPP may be an effective strategy to improve residents' satisfaction with CPA tumor theory exam scores and self-evaluation. PPP teaching method is helpful to improve the teaching effect, so it is worth widely adopting in teaching. However, the effect of PPP in the teaching of residents in other departments, superior physicians, other medical professionals, and other neurological diseases other than tumors in CPA area needs to be comprehensively studied. Future research should explore these pedagogical pathways.

PBL Problem-Based Learning

PPT Prescription-based preoperative talk

CPA Cerebellopontine angle

PPT PBL and PPT

Acknowledgements

We would like to acknowledge and thank the residents who participated in this study and provided valuable feedback.

Authors’ contributions

Kailiang Zhang and Caizhi Ma designed the study and wrote the main manuscript text. Xiaojie Xue and Jianquan Man made the test questions and questionnaires, and made tables and figures. Fenfen Xu and Alphonce M.K Nyalali edited the manuscript. All authors reviewed the manuscript.

Funding

No.

Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

This study was approved by the Ethics Committee of Qilu Hospital of Shandong University. Written informed consent was obtained from all participating students. We confirm that all experiments were performed in accordance with relevant guidelines and regulations.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Chan Z, et al. A systematic review of qualitative studies: patients' experiences of preoperative communication. J Clin Nurs. 2012;21(5–6):812–24.
Riedl D, Schüßler G. The Influence of Doctor-Patient Communication on Health Outcomes: A Systematic Review. Z Psychosom Med Psychother. 2017;63(2):131–50.
Singh M. Communication as a Bridge to Build a Sound Doctor-Patient/Parent Relationship. Indian J Pediatr. 2016;83(1):33–7.
Liang H, et al. Meta-analysis and systematic review of counselling on surgery. Ann Palliat Med. 2021;10(5):5641–51.
Zhao W, et al. The effectiveness of the combined problem-based learning (PBL) and case-based learning (CBL) teaching method in the clinical practical teaching of thyroid disease. BMC Med Educ. 2020;20(1):381.
Yan X, et al. Enhancing medical education in respiratory diseases: efficacy of a 3D printing, problem-based, and case-based learning approach. BMC Med Educ. 2023;23(1):512.
Berger C, et al. Combination of problem-based learning with high-fidelity simulation in CPR training improves short and long-term CPR skills: a randomised single blinded trial. BMC Med Educ. 2019;19(1):180.
Chang G, et al. Problem-based learning: its role in undergraduate surgical education. Can J Surg. 1995;38(1):13–21.
Cogbill TH, Shapiro SB. Transition from Training to Surgical Practice. Surg Clin North Am. 2016;96(1):25–33.
Fajardo-Ortiz G, Robledo H. Management of medical care, a fundamental tool for resident doctors. Cir Cir. 2019;86(1):65–72.
You YP, et al. Vestibular schwannoma surgical treatment. CNS Neurosci Ther. 2013;19(5):289–93.
Samii M, Gerganov VM. Tumors of the cerebellopontine angle. Handb Clin Neurol. 2012;105:633–9.
Kartush JM, Brackmann DE. Acoustic neuroma update. Otolaryngol Clin North Am. 1996;29(3):377–92.
Carlson ML, Link MJ. Vestib Schwannomas N Engl J Med. 2021;384(14):1335–48.
Morton DA, Colbert-Getz JM. Measuring the impact of the flipped anatomy classroom: The importance of categorizing an assessment by Bloom's taxonomy. Anat Sci Educ. 2017;10(2):170–5.
Liu CX, et al. Comparing hybrid problem-based and lecture learning (PBL + LBL) with LBL pedagogy on clinical curriculum learning for medical students in China: a meta-analysis of randomized controlled trials. Med (Baltim). 2020;99(16):e19687.
Vega-Hurtado C. [Importance of doctor-patient communication strategies]. Rev Med Inst Mex Seguro Soc. 2020;58(2):197–201.

Table 1 and 2 are available in the Supplementary Files section.

No competing interests reported.

Table1.pdf
Table2.pdf
Precoursetest.docx
Supplementary Material 1. Pre-course test
Postcoursetest.docx
Supplementary Material 2. Post-course test
1montest.docx
Supplementary Material 3. Test after 1 month of teaching

Download PDF

Version 1

posted

You are reading this latest preprint version

Problem-based learning-standardized preoperative conversation improves neurosurgery residents' understanding of cerebellopontine angle tumors

Status:

Version 1

Abstract

Objectives

Methods

Results

Conclusion

Figures

Introduction

Methods

Participants

Study design

PPP group

Control group

Assessment tools

Theoretical assessment

Satisfaction evaluation

Statistical analysis

Results

The scores of the PPP group and the control group were compared

PPP group teaching satisfaction questionnaire

Discussion

Conclusion

Abbreviations

Declarations

References

Tables

Additional Declarations

Supplementary Files

Status:

Version 1