Comparison of Asynchronous M-learning with Faculty-led Discussion in Undergraduate Medical Education

Purpose: The authors sought to explore m-learning as a means to provide patient case exposure to pre-clinical medical students in the support of developing their clinical reasoning. Methods: This was a randomized crossover comparison of mobile app use versus live session on diagnostic pathways for patient presentations of dizziness and weakness. Second-year medical students were randomized to access one of four cases (2 weakness pathway, 2 dizziness pathway) in a mobile application, then all attended a live session covering all four cases. Measures for user experience, self-efficacy and clinical reasoning at three study timepoints are reported. Differences between participants and cases analyzed with Chi-squared test. Continuous variables were compared between groups using Kruskal-Wallis or Wilcoxon rank sum test. Interaction contrasts for case, pathway and timepoint were analyzed for changes in self-efficacy and MCQ scores. Results: 42 students spent an average of 26.5 minutes for app case, with no significant differences between groups and case metrics. Learners’ scores improved before and after using the app on the MCQ items that related to their assigned case (mean 14%, SD 6%, interaction contrast p=0.03), but not on MCQ items related to the unassigned case from their pathway (p=0.71) or the case from the other pathway (p=0.78). Before and after the live session, all learners improved uniformly across pathways and cases. Group A alone rated the app as more engaging by Likert Scale (App Mean 5.3, SD 1.3; Lecture Mean 4.4 (1.4), p=.031) Conclusion: M-learning via an application targeting clinical reasoning skills in diagnosis is correlated with case-specific knowledge acquisition and general increases in self-efficacy for pre-clinical medical students. Tailoring level of case complexity to learner level may increase impact.