Effectiveness of a multi-model teaching strategy to train emergency medicine residents to use point-of-care ultrasound (POCUS) for assessment of shock | BMC Medical Education

Practice of “multimodal Visualization-Mind Mapping-Blended – POCUS”

Visualized teaching

The findings demonstrate that integrating POCUS with multimodal teaching methods significantly enhances the effectiveness of clinical training and improves trainees’ comfort levels. Visualization-based instruction plays an indispensable role in this process. The application of POCUS visual teaching can more vividly and intuitively display the pathophysiology of critical illness through multimedia forms such as images, videos, and animations, making the learning process concrete and interactive. Teachers can use visual ultrasound to transform abstract and complex physiology, pathophysiology, and anatomy into intuitive and simple images and use interactive visual learning methods to help residents better understand and remember the key of knowledge [16]. Two studies showed that ^, with the help of three-dimensional visualization methods such as 3D animation, video teaching, virtual laboratories, VR and other methods to display anatomical structure and function in orthopedic clinical teaching, have shown that students can learn anytime and anywhere, improving the convenience and flexibility of learning [17, 18]. In addition to its application in the classroom, visualized teaching plays an important role in the fields of online education and distance learning. With visual images, the POCUS teaching method could help establish “visual thinking strategies” through visual assessment [19]. Combined with multimodal teaching methods, video conferencing can stimulate students’ enthusiasm for learning, improve learning effects, and make the hemodynamics of shock more concrete [20]. One study reported that the application of visual teaching methods in orthopedic clinical teaching has significant effects and is worth promoting in critical care medicine education [21].

Mind mapping

A study revealed that web-based mind mapping combined with standardized patient protocols can improve students’ theoretical knowledge, communication skills and self-efficacy in clinical scenarios [22]. Mind mapping and concept maps assist students in answering their questions, and “visual mapping” presented in the form of mind and concept maps helps promote their thinking [23, 24]. The mind mapping of this research project presents shock pathophysiology and anatomy, such as the inferior vena cava, right heart, left heart, and ventricular outflow tract, in the form of mind and concept maps, which help recall the learned information for residents and acquire information quickly and accurately. Combined with the problem-oriented method, it improves reading ability and the ability to construct key words to descriptive questions in a structured and concrete way [25, 26].

Blended learning

Blended teaching is a teaching model that integrates traditional face-to-face teaching and online teaching. Several studies have shown that blended teaching provides students with a more flexible and personalized learning experience through traditional classroom teaching, flipped classrooms and web-based learning resources [27,28,29]. In this study, residents participated in discussions about POCUS, watched course videos, and completed test assignments online at any time and from anywhere, which not only improved students’ learning efficiency but also promoted interaction and cooperation among the residents. This study integrated the flipped classroom format into the teaching methodology, employing typical shock cases and adopting a problem-oriented approach to foster critical clinical thinking skills among students [30, 31]. It was structured into phases aligned with the shock treatment process of rescue, optimization, stabilization, and evacuation. By blending experiential learning and mobile learning directly at the bedside, residents were able to engage more deeply in the material, fostering a greater understanding and application of knowledge. Consequently, the adoption of a blended teaching model directs learners to conduct their learning independently, in a suitable manner and with an attitude toward in-depth learning.

POCUS teaching

As an extension of clinical examination and a tool for diagnosis, POCUS has become a signature bedside technology for clinicians [32]. POCUS plays a role in almost all medical specialties and is used in disciplines around the world, especially in critical care specialties [33]. POCUS effectively fills the gap between physical examination and imaging equipment, such as CT or MRI, with the characteristics of being used at the patient’s bedside to answer specific clinical questions, evaluate treatment and guide clinical decisions. Among them, POCUS has an irreplaceable position in focused cardiac ultrasound, lung ultrasound, E-fast, and volume assessment [34, 35]. Early POCUS training can enhance students’ understanding of organ anatomy and physiology, facilitate qualitative assessments of acute and critical illnesses, and consequently improve their ability to make clinical decisions. By improving students’ ability to acquire precise ultrasound images, diagnostic errors in the future can be reduced among medical students, thereby enhancing their clinical reasoning. Providing comprehensive ultrasound education to residents is a fundamental prerequisite for ensuring the delivery of high-quality clinical practice, and it should be vigorously encouraged and supported [36, 37]. This study integrated a multimodal teaching curriculum with bedside ultrasound imaging technology in an effort to enhance residents’ clinical thinking and participation in clinical practice. The results indicate that the TR group demonstrated higher levels of learning engagement compared to the TT group, suggesting that POCUS-guided teaching enhances teacher-student interaction and increases residents’ motivation. These findings underscore the significance of POCUS in improving the quality of medical education.

Several studies have shown that an increasing number of medical schools have incorporated POCUS into clinical courses and that residents have generated more demand for course training resources [38]. First, standardized training can help POCUS trainees acquire the necessary knowledge, skills, and behaviors at the beginning of their training, enabling them to reach a certain level of foundational knowledge. As new technologies have advanced deeply in the field of ultrasound, artificial intelligence, remote education, and immersive virtual reality have gradually been applied in the POCUS domain [39, 40]. The utilization of new technologies such as online learning and peer-assisted learning can enhance practical competencies, allowing the transition of bedside ultrasound from supervised to unsupervised practice [33, 41]. Importantly, the practical ability in POCUS is not necessarily proportional to the level of professional knowledge mastery. Regardless of the stage of practice, there are times when it is necessary to seek advice and guidance from a more experienced practitioner. Meanwhile, they should be interpreted with the patient’s pathophysiology dynamically and repeatedly [33].

Evaluation of the effectiveness of multimodal teaching

The integration of constructivism, cognitive load theory, and self-regulated learning provides a powerful framework for the design and implementation of our programs, while advocating the use of multimodal learning analytics to capture and analyze disparate data sources such as performance metrics, engagement, and behavior patterns [42]. In our study, we took a similar approach to evaluate the effectiveness of our POCUS training program. Our findings are consistent with the theoretical insights provided by Giannakos and Cukurova, suggesting that a multi-model teaching strategy based on learning theory can significantly improve skill acquisition and adaptability in POCUS training. Multimodal teaching combines traditional face-to-face teaching with modern technology teaching methods. By integrating different teaching resources and methods, multimodal teaching aims to improve residents’ learning outcomes and education quality. Malhotra demonstrated the effectiveness of a multimodal approach grounded in constructivism and cognitive flexibility theory for interprofessional education [43]. Their findings support the use of diverse teaching methods, such as simulations and case-based learning, to enhance the acquisition and application of POCUS skills in emergency medicine residents. When evaluating the effectiveness of multimodal teaching, the following aspects can be considered. The first is the residents’ academic performance. We can compare the residents’ test scores, classroom performance and other data under the teaching model to judge whether there is a significant improvement. The second is residents’ learning interest and participation. We can observe in detail whether residents are more actively involved in learning activities under multimodal teaching and whether they are more interested in the course content. The third is the improvement of residents’ comprehensive abilities. Multimodal teaching emphasizes the cultivation of residents’ comprehensive qualities, such as innovative thinking and teamwork ability, which can be evaluated through daily observations and questionnaire surveys.

In this study, the theoretical and practical assessment scores of the residents in the TR group were significantly better than those in the TT group. In terms of teaching satisfaction, the results revealed that the satisfaction evaluation indicators of the TR group were better than those of the TT group. The evaluation of overall teaching revealed that the overall teaching satisfaction of the residents in the TR group was significantly better than that of those in the TT group. This shows that the application of “POCUS combined with a multimodal teaching method” in emergency training can improve the clinical skills of residents, meaning that the teaching reform method is feasible in education reform. In summary, we believe that the effectiveness of multimodal teaching in emergency residency training can be attributed to the following key factors: First, multisensory integration plays a critical role in multimodal teaching by combining visual, auditory, and tactile inputs to activate different regions of the brain, thereby facilitating deeper information processing and long-term memory retention [44]. Second, The integration of theory and practice is essential, as simulated scenarios, case analyses, and hands-on practice enable trainees to directly apply theoretical knowledge to practical situations, thereby reinforcing learning outcome [45]. Additionally, Personalized learning is a significant advantage of multimodal teaching, as it adapts to individual learning progress and characteristics by offering tailored content and pacing. This approach ensures that learners receive instruction aligned with their unique strengths, weaknesses, and preferences, thereby addressing diverse learning needs. By accommodating different learning styles and paces, multimodal teaching not only enhances engagement but also optimizes knowledge retention and skill acquisition, ultimately improving overall learning efficiency [46]. Last but not least, enhanced engagement is achieved through diverse teaching methods. For example, interactive instruction and gamified learning, stimulate residents’ interest and increase their participation and focus.

Due to its flexibility and versatility, multimodal teaching method can be applied to a wide range of scenarios, particularly in fields such as education, healthcare, vocational training, and technology development [47]. By leveraging tools such as virtual laboratories, interactive simulations, and visualization technologies, it helps learners master complex skills, understand abstract concepts, and provides ongoing professional development support. Multimodal teaching approach is particularly well-suited for undergraduate medical education, which provides personalized learning resources and adaptive teaching strategies, facilitates the sharing and exchange of educational resources, and maximizes resource utilization [48].

Combined with POCUS, the multimodal integrated teaching system in this project remains an exploratory subject. Owing to the lack of a well-designed POCUS curriculum, the popularization of POCUS training systems has not yet been fully incorporated into medical school courses. Therefore, resident physicians lack intuitive and visual tools to address clinical challenges, particularly in resource-limited areas, where they lack awareness of the importance of POCUS in the medical field. The results of this study indicate that POCUS serves as a practical tool and skill that can enrich medical residents’ learning experiences and that additional practical skills courses enhance medical residents’ capabilities, confidence, and attitudes.

Limitations

This study evaluated the effectiveness of standardized training for residents under multimodal teaching methods, reflecting the real-world scenario of using POCUS to respond to critical and emergency situations. However, this study has certain limitations. First, residentsrecruited from various semesters of clinical training within the same medical institution presented heterogeneous knowledge reserves, potentially contributing to the inhomogeneity of teaching. Second, the implementation of short-term training courses as interventions might not adequately foster enduring learning abilities, as knowledge reserves and skill retention over time could affect subsequent clinical practice. Therefore, a strategy worth exploring is the combination of longitudinal training with periodic reinforcement. Third, the study population was relatively small, as all standardized training students must actively apply for the course, necessitating further expansion of the teaching population. Fourth, there was a deficiency in the supervision of teaching quality between the TR and TT groups, leading to the variability in the delivery and consistency of instructional methods and failing to promptly identify the problems and deficiencies in the process and put forward suggestions and measures for improvement, which necessitates continuous optimization. Finally, the scoring indicators we used to evaluate the effectiveness of course training have not been validated previously and need to be further optimized.