Effectiveness of Blended Learning in Teaching Basic Practical Otorhinolaryngology Skills: Pandemic Lessons and Key Influencing Factors

Jonas Engert^1,*, Nyat Tecle¹, Bjoern Spahn¹, Joy Backhaus², Linda Henig², Kristen Rak¹, Fabian Kraus¹, Agmal Scherzad¹, Pascal Ickrath¹, Johannes Voelker¹, Sarah König², Stephan Hackenberg¹, Stefan Kaulitz¹

¹Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Wuerzburg, Wuerzburg 97080, Germany.

²Institute for Medical Teaching and Medical Educational Research, University Hospital Wuerzburg, Wuerzburg 97080, Germany.

*Corresponding author: Jonas Engert

This article belongs to Special Issue “The Impact of COVID-19 on Contemporary Education”.

Published: March 4,2025

Abstract

The SARS-CoV-2 pandemic brought unprecedented challenges to medical education, particularly in teaching practical skills. These challenges catalyzed the adoption of digital and hybrid teaching methods, reshaping traditional teaching approaches. This study evaluates the effectiveness of blended learning, which integrates digital and in-person instructions, for teaching basic practical otorhinolaryngology examination skills and explores factors influencing its success. During the winter semester of 2020/2021, fourth-year medical students at the University of Wuerzburg participated in a blended learning program comprising a digital course with self-guided practice using examination kits, followed by an on-site course, concluding an objective structured clinical examination (OSCE). Students were divided into cohorts based on whether they received supervised clinical teaching prior to the OSCE. Performance data, along with a comprehensive survey covering demographics, preparation, interest, and self-evaluation, were analyzed to identify key factors impacting outcomes. Results revealed that students who underwent supervised clinical teaching scored significantly higher on the OSCE compared to those in the online-only cohort. Notably, gender disparities were observed, with male students outperforming females; however, this gap was mitigated among students with high self-assessed musical abilities. Additionally, self-evaluation of practical skills strongly correlated with OSCE performance, underscoring its importance in psychomotor skill acquisition. Survey findings highlighted the perceived value of the blended approach, with supervised clinical teaching rated as more beneficial than digital-only methods for mastering hands-on competencies. This study demonstrates that blended learning is an effective strategy for teaching practical otorhinolaryngology skills, offering significant advantages over online-only approaches. However, its success depends on addressing factors such as gender disparities and promoting extra-curricular activities, like music, to enhance manual dexterity and confidence. The findings provide a robust framework for integrating hybrid teaching formats into post-pandemic medical education.

References

Carson, J. A., Peets, A., Grant, V., & McLaughlin, K. (2010). The Effect of Gender Interactions on Students' Physical Examination Ratings in Objective Structured Clinical Examination Stations. Academic Medicine, 85(11), 1772-1776.

https://doi.org/10.1097/ACM.0b013e3181f52ef8

Chan, M., Bax, N., Woodley, C., Jennings, M., Nicolson, R., & Chan, P. (2015). The first OSCE; does students’ experience of performing in public affect their results? BMC Medical Education, 15(1), 59. https://doi.org/10.1186/s12909-015-0343-0

Eva, K. W., Cunnington, J. P. W., Reiter, H. I., Keane, D. R., & Norman, G. R. (2004). How Can I Know What I Don't Know? Poor Self Assessment in a Well-Defined Domain. Advances in Health Sciences Education, 9(3), 211-224.

https://doi.org/10.1023/B:AHSE.0000038209.65714.d4

Grasl, M. C., Pokieser, P., Gleiss, A., Brandstaetter, J., Sigmund, T., Erovic, B. M., & Fischer, M. R. (2012). A New Blended Learning Concept for Medical Students in Otolaryngology. Archives of Otolaryngology–Head & Neck Surgery, 138(4), 358-366.
https://doi.org/10.1001/archoto.2012.145

Hoaglin, D. C., & Iglewicz, B. (1987). Fine-tuning some resistant rules for outlier labeling. Journal of the American statistical Association, 82(400), 1147-1149.

Jonck, C., Weimer, A. M., Fundel, B., Heinz, W., Merkel, D., Fiedel, H., Ille, C., Kloeckner, R., Buggenhagen, H., Piepho, T., & Weimer, J. (2024). Development and evaluation of a point-of-care ultrasound curriculum for paramedics in Germany – a pro-spective observational study and comparison. BMC Medical Education, 24(1), 811. https://doi.org/10.1186/s12909-024-05816-1

Kaulitz, S., Engert, J., Roos, C., Filsinger, M., Konig, S., & Hackenberg, S. (2020). Digital practical course of otorhinolaryngology and examination technique "to go". GMS J Med Educ, 37(7), Doc67. https://doi.org/10.3205/zma001360

Knief, U., & Forstmeier, W. (2021). Violating the normality assumption may be the lesser of two evils. Behav Res Methods, 53(6), 2576-2590. https://doi.org/10.3758/s13428-021-01587-5

Kobicheva, A., Tokareva, E., & Baranova, T. (2022). Students’ Affective Learning Outcomes and Academic Performance in the Blended Environment at University: Comparative Study. Sustainability, 14(18), 11341.

https://www.mdpi.com/2071-1050/14/18/11341

Krambeck, A., Loth, A. G., Leinung, M., Syed-Ali, A., Filmann, N., Kramer, S., Baumann, U., Stöver, T., & Diensthuber, M. (2022). [Has the SARS-CoV-2 pandemic improved teaching?-Virtual education in otorhinolaryngology from the students' perspective]. HNO, 70(9), 655-665. https://doi.org/10.1007/s00106-022-01192-8 (Hat die SARS-CoV-2-Pandemie die Lehre verbessert? – Virtueller Unterricht im Fach HNO-Heilkunde aus Sicht der Studierenden.)

Lechner, A., Haider, S. P., Branz, P. E., Paul, B., Kashani, F., Canis, M., Schrötzlmair, F., & Sharaf, K. (2024). Medical education during the COVID-19 pandemic: An online-only course can achieve good to medium psychomotor skill level of basic head and neck examination. Heliyon, 10(19), e38044. https://doi.org/https://doi.org/10.1016/j.heliyon.2024.e38044

Lechner, A., Haider, S. P., Paul, B., Escrihuela Branz, P. F. F., Felicio-Briegel, A., Widmann, M., Huber, J., Stadlberger, U., Canis, M., Schrötzlmair, F., & Sharaf, K. (2022). Misjudgment of Skills in Clinical Examination Increases in Medical Students Due to a Shift to Exclusively Online Studies during the COVID-19 Pandemic. Journal of Personalized Medicine, 12(5), 781.

https://www.mdpi.com/2075-4426/12/5/781

Lüdke, T., Polk, M.-L., Günther, S., Kluge, A., Zahnert, T., & Neudert, M. (2023). Digital teaching and assessment of psychomotor skills of the clinical head and neck examination during COVID-19 pandemic. European Archives of Oto-Rhino-Laryngology, 280(11), 4835-4844.
https://doi.org/10.1007/s00405-023-07998-8

Offergeld, C., Ketterer, M., Neudert, M., Hassepaß, F., Weerda, N., Richter, B., Traser, L., Becker, C., Deeg, N., Knopf, A., Wesarg, T., Rauch, A. K., Jakob, T., Ferver, F., Lang, F., Vielsmeier, V., Hackenberg, S., Diensthuber, M., Praetorius, M., . . . Hil-denbrand, T. (2021). “Ab morgen bitte online”: Vergleich digitaler Rahmenbedingungen der curricularen Lehre an nationalen Universitäts-HNO-Kliniken in Zeiten von COVID-19. HNO, 69(3), 213-220. https://doi.org/10.1007/s00106-020-00939-5

Paul, A., Leung, D., Salas, R. M. E., Cruz, T. E., Abras, C., Saylor, D., Gugliucciello, V., Nunn, J., Gamaldo, C. E., & Strowd, R. E. (2023). Comparative effectiveness study of flipped classroom versus online-only instruction of clinical reasoning for medical students. Med Educ Online, 28(1), 2142358.
https://doi.org/10.1080/10872981.2022.2142358

Rao, N., Swaby, J., & Nehra, D. (2015). Can a hobby influence medical students’ suturing skills? The Bulletin of the Royal College of Surgeons of England, 97, 387-391.
https://doi.org/10.1308/rcsbull.2015.387

Rasch, D., & Guiard, V. (2004). The robustness of parametric statistical methods.

Rasch, D., Kubinger, K. D., & Moder, K. (2011). The two-sample t test: pre-testing its assumptions does not pay off. Statistical Papers, 52(1), 219-231.
https://doi.org/10.1007/s00362-009-0224-x

Robb, K. A., Rosenbaum, M. E., Peters, L., Lenoch, S., Lancianese, D., & Miller, J. L. (2023). Self-Assessment in Feedback Conversations: A Complicated Balance. Academic Medicine, 98(2), 248-254. https://doi.org/10.1097/acm.0000000000004917

Schmitz, L., Betz, C. S., Böttcher, A., Häußler, S. M., & Praetorius, M. (2024). Wieviel Digitalisierung braucht die HNO-Lehre? HNO, 72(5), 325-333.
https://doi.org/10.1007/s00106-024-01437-8

Seiwerth, I., Bartel, S., Herzog, M., Schumann, G., Pein, M. K., Gey, A., & Plontke, S. K. (2022). [Teaching during the COVID-19 pandemic: how do medical students evaluate interactive video-based distance bedside teaching in otorhinolaryngology?]. HNO, 70(2), 140-147. https://doi.org/10.1007/s00106-021-01117-x (Ausbildung in COVID-19-Pandemie-Zeiten: Wie bewerten Medizinstudierende einen interaktiven, videobasierten Distanzunterricht am Patienten im Fach Hals-Nasen-Ohren-Heilkunde?)

Shaiba, L. A., Alnamnakani, M. A., Temsah, M.-H., Alamro, N., Alsohime, F., Alrabiaah, A., Alanazi, S. N., Alhasan, K., Alherbish, A., Mobaireek, K. F., Bashiri, F. A., & AlRuthia, Y. (2021). Medical Faculty’s and Students’ Perceptions toward Pediatric Elec-tronic OSCE during the COVID-19 Pandemic in Saudi Arabia. Healthcare, 9(8), 950.

https://www.mdpi.com/2227-9032/9/8/950

Shan, G., & Gerstenberger, S. (2017). Fisher's exact approach for post hoc analysis of a chi-squared test. PLoS One, 12(12), e0188709. https://doi.org/10.1371/journal.pone.0188709

Weimer, J. M., Recker, F., Horn, L., Kuenzel, J., Dirks, K., Ille, C., Buggenhagen, H., Börner, N., Weimer, A. M., Vieth, T., Lorenz, L., Rink, M., Merkel, D., Dionysopoulou, A., Ludwig, M., Kloeckner, R., Weinmann-Menke, J., & Müller, L. (2024). Insights Into Modern Undergraduate Ultrasound Education: Prospective Comparison of Digital and Analog Teaching Resources in a Flipped Classroom Concept—The DIvAN Study. Ultrasound Int Open, 10(continuous publication).

https://doi.org/10.1055/a-2389-9410

How to cite this paper

Effectiveness of Blended Learning in Teaching Basic Practical Otorhinolaryngology Skills: Pandemic Lessons and Key Influencing Factors

How to cite this paper: Jonas Engert, Nyat Tecle, Bjoern Spahn, Joy Backhaus, Linda Henig, Kristen Rak, Fabian Kraus, Agmal Scherzad, Pascal Ickrath, Johannes Voelker, Sarah König, Stephan Hackenberg, Stefan Kaulitz. (2025). Effectiveness of Blended Learning in Teaching Basic Practical Otorhinolaryngology Skills: Pandemic Lessons and Key Influencing Factors. The Educational Review, USA, 9(2), 154-163.

DOI: http://dx.doi.org/10.26855/er.2025.02.001

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