Computational protocol: Implementing blended learning in emergency airway management training: a randomized controlled trial

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Protocol publication

[…] Junior doctors working in the emergency department of Sarawak General Hospital, Malaysia were invited to participate in this study. We define a “junior doctor” as a doctor in his or her second and third year of clinical service. The reason for choosing junior doctors in their second or third year of clinical service (rather than those in their first year of service) is because these doctors have had at least 1 year of basic clinical experience which we believe enables them to better comprehend the contents of this training and to actively participate in the discussions with critical thinking skills. Any junior doctor who had participated in any prior airway training course was excluded from the study. Informed consents were obtained from all participants prior to their participation in this study. The detailed descriptions of the participants are given in Table .The sample size estimation was calculated based on the 2-mean formula on the G*Power software version [] based on a study by Lancester et al. in 2012 which compared examination scores of nursing degree students who went through either traditional or blended methods of lecture delivery on pharmacotherapeutics []. In that study, it was found that the mean scores were 92.7 +/− 3.8 and 96.6 +/− 1.9 for traditional learning and blended learning respectively []. Therefore, using a priori analysis with a 95% power of study with an alpha of 0.05, a total sample size of 28 with 14 in each group was determined. This sample size was further inflated by 10% to compensate for potential drop out, thus making our sample size 30 participants in total, or 15 participants in each arm. [...] The study was divided into two stages. The first stage was the development of teaching contents and assessment questions using a modified Delphi method in three rounds of online discussion. As the experts are based in different locations within Malaysia, a video conferencing discussion was carried as the first round of discussion. In this round, the overarching aims and objectives of the workshop were clarified among the experts. The experts then listed out the probable topics for the workshop as well as the assessment questions. Topics of interest were then emailed by the experts to author MHTK who was responsible in compiling them. In the second round of online discussion, the list of topics were then emailed out by author MHTK to all experts who then scrutinized and gave their suggestions to these topics. The agreed topics were then compiled by author MHTK and emailed out again to all experts for a third round of online discussion. In this round, specific tasks of preparing the lecture notes, presentation slides and video lectures were assigned to specific experts. Experts also contributed the pre-test and post-test assessment questions (comprising of four sections: 1) one best answer (OBA) 2) true/false section (T/F) 3) “fill-in-the-blanks” and 4) practical skills stations) (see Additional file : Table S1 for the detailed descriptions). These questions were then vetted and agreed upon by the experts. Any differences in opinion among the experts were resolved via further discussions and consensus.For participants in the BL arm, the notes were uploaded in the learning management system (URL:; whereas for participants in the F2FL arm, it was in the form of printed handouts). Online activities in the form of quizzes, “fill in the blanks”, and crossword puzzle were created for participants in BL arm. A similar quiz was prepared for those in the F2FL arm as well, but the “fill in the blanks” and crossword puzzle were not administered to the F2FL arm as these are optional enhancing activities in a BL setting.The learning management system was then checked independently by 2 of the researchers (MNA and KMC); and all errors were rectified before the online course was opened for enrollment. All participants (from both arms of the study) participated in this study without any fee or charges.The second stage of this study was participant recruitment and randomization as well as the implementation of educational interventions. Junior doctors who consented to this voluntary, anonymous study were first randomized using an online number generator ( into either the BL arm or the F2FL arm. Upon registration, all participants completed a pre-test theory & practical assessment by an independent emergency physician who was blinded to the participants’ study arms. To assess their information and communication technology (ICT) skills, participants in the BL arm also completed a validated questionnaire on ICT skills using a Likert scale from 0 to 10 where 0 means the participant finds it the easiest to perform the ICT task and 10 means the participant finds it the hardest to perform the ICT task []. The information gleaned from these participants’ prior ICT skills were then analyzed for any possible correlation between their ICT skill proficiency levels with the scores they obtained. Participants from the BL arm had access to the online learning materials, online quizzes and discussions via an online blended learning classroom for 12 days before they joined participants from the F2FL arm for the one-day hands-on session. A social networking messaging application was utilized to enhance discussions among participants and the instructors. For the F2FL arm, the exact same lecture notes were made available to them for 12 days before the first day of the workshop. They then attended an 8-h one-day of F2FL lectures covering all of the above-mentioned modules on emergency airway management using PowerPoint slides with the same content as that which was used for video lectures. Time was allocated after each lecture for discussion and to answer any questions that the participants had. They also participated in a group quiz and also watched video demonstration of certain procedures relevant to emergency airway management (available also on the online learning system). Participants from the F2FL arm underwent a one-day (or 8 h) training consisting of face-to-face classroom lectures. This was followed by a one-day hands-on session consisting of simulation skill training with airway manikins. All participants then completed a post-test theory and practical assessment by the same emergency physician who conducted the pre-test practical assessment. The assessor was blinded to the participants’ arm all throughout the study.In addition, participants from the BL arm also answered a validated quantitative e-learning experience questionnaire adapted from Ginns & Ellis (2007) [] and a qualitative questionnaire to gauge their perception towards blended learning, adapted from Larsen (2012) []. All the quantitative data that was collected was then analyzed using IBM SPSS Statistics 15.0 for Windows. Thematic analysis was manually performed to code or interpret the qualitative data. […]

Pipeline specifications

Software tools G*Power, SPSS
Application Miscellaneous
Organisms Homo sapiens