Document Type : Original Article
Authors
- . Hosein Habibzadeh
- . Alireza Rahmani
- . Bahlol Rahimi
- . Soheila Ahangarzadeh Rezai
- . Nader Aghakhani
- . Fariba Hosseinzadegan
Departments of Nursing and Health Information Technology, Urmia University of Medical Sciences, Urmia, Iran
Abstract
INTRODUCTION: Due to the importance of correct interpretation of electrocardiogram (ECG) in the
quality of healthcare delivery, new educational methods are increasingly being implemented and
evaluated. In this regard, the purpose of this study was to compare the traditional and virtual teaching
methods on the interpretation of cardiac dysrhythmia in nursing students.
METHODS: The present study is a quasi‑experimental research with pretest and posttest design.
Sixty nursing students in the seventh semester from schools of nursing in Urmia and Khoy cities
were randomly assigned to two virtual and traditional education groups. Students’ knowledge was
measured by a researcher‑made 30‑item test.
RESULTS: The mean and standard deviation of the students’ scores in the traditional education
group was 11.20 ± 4.41 and 14.40 ± 4.62 and in the virtual group was 11.30 ± 2.74 and 18.43 ± 4.68,
pre‑ and post‑training, respectively. Paired t‑test showed a significant difference between the
mean score of pretest and posttest in both types of training (P < 0.001). According to the results of
independent sample t‑test, there were no significant differences between the two groups before the
training (P > 0.05). However, in the posttraining period, there were significant differences between
traditional and virtual education groups (P < 0.001).
CONCLUSION: Considering the results of this study, which shows the positive effects of virtual
education method on nursing students’ knowledge about cardiac dysrhythmia, this method can be
used as an alternative or complementary method to the traditional education.
Keywords
1. Pontes PA, Chaves RO, Castro RC, de Souza ÉF, Seruffo MC,
Francês CR. Educational software applied in teaching
electrocardiogram: A systematic review. Biomed Res Int
2018;2018:8203875.
2. Raupach T, Harendza S, Anders S, Schuelper N, Brown J. How
can we improve teaching of ECG interpretation skills? Findings
from a prospective randomised trial. J Electrocardiol 2016;49:7‑12.
3. Viljoen CA, Scott Millar R, Engel ME, Shelton M, Burch V.
Is computer‑assisted instruction more effective than other
educational methods in achieving ECG competence among
medical students and residents? Protocol for a systematic review
and meta‑analysis. BMJ Open 2017;7:e018811.
4. Davies A, Vigo M, Harper S, Jay C. The visualisation of
eye‑tracking scanpaths: What can they tell us about how
clinicians view electrocardiograms? IEEE Second Workshop on
Eye Tracking and Visualization (ETVIS). In: Eye Tracking and
Visualization (ETVIS). Baltimore, MD, USA: IEEE; 2017. p. 1‑6.
5. LakK, ZareieF, HabibzadehH, MohammadpourY, RahnemoonK,
Zare H, et al. A survey on the effect of educational software
method of arrhythmias stimulator on the level of knowledge of
electrocardiograms interpretation in nurses. Iran J Crit Care Nurs
2013;6:173‑80.
6. Funk M, Fennie KP, Stephens KE, May JL, Winkler CG, Drew BJ,
et al. Association of implementation of practice standards for
electrocardiographic monitoring with nurses’ knowledge, quality
of care, and patient outcomes: Findings from the practical use of
the latest standards of electrocardiography (PULSE) trial. Circ
Cardiovasc Qual Outcomes 2017;10. pii: e003132.
7. Brooks CA, Kanyok N, O’Rourke C, Albert NM. Retention of
baseline electrocardiographic knowledge after a blended‑learning
course. Am J Crit Care 2016;25:61‑7.
8. Granero‑Molina J, Fernández‑Sola C, López‑Domene E,
Hernández‑Padilla JM, Preto LS, Castro‑Sánchez AM. Effects
of web‑based electrocardiography simulation on strategies and
learning styles. Rev Esc Enferm USP 2015;49:650‑6.
9. Omidifar N, Yamani N, Yousefi A. The effect of ECG training
workshop on medical students’ knowledge of ECG reading and
interpretation. J Strides Dev Med Educ 2007;3(2):118‑25.
10. Breen CJ, Kelly GP, Kernohan WG. ECG interpretation skill
acquisition: A review of learning, teaching and assessment.
J Electrocardiol 2019. pii: S0022‑0736(18)30641‑1.
11. Moffett J, Berezowski J, Spencer D, Lanning S. An investigation
into the factors that encourage learner participation in a large
group medical classroom. Adv Med Educ Pract 2014;5:65‑71.
12. Fent G, Gosai J, Purva M. Teaching the interpretation of
electrocardiograms: Which method is best? J Electrocardiol
2015;48:190‑3.
13. Luscombe C, Montgomery J. Exploring medical student learning
in the large group teaching environment: Examining current
practice to inform curricular development. BMC Med Educ
2016;16:184.
14. Mahler SA, Wolcott CJ, Swoboda TK, Wang H, Arnold TC.
Techniques for teaching electrocardiogram interpretation:
Self‑directed learning is less effective than a workshop or lecture.
Med Educ 2011;45:347‑53.
15. Fincher RM, Abdulla AM, Sridharan MR, Houghton JL, Henke JS.
Teaching fundamental electrocardiography to medical students:
Computer‑assisted learning compared with weekly seminars. Res
Med Educ 1987;26:197‑202.
16. Losco CD, Grant WD, Armson A, Meyer AJ, Walker BF. Effective
methods of teaching and learning in anatomy as a basic science:
A BEME systematic review: BEME guide no 44. Med Teach
2017;39:234‑43.
17. Montassier E, Hardouin JB, Segard J, Batard E, Potel G,
Planchon B, et al. E‑learning versus lecture‑based courses in ECG interpretation for undergraduate medical students: A randomized
noninferiority study. Eur J Emerg Med 2016;23:108‑13.
18. Nilsson M, Bolinder G, Held C, Johansson BL, Fors U, Ostergren J,
et al. Evaluation of a web‑based ECG‑interpretation programme
for undergraduate medical students. BMC Med Educ 2008;8:25.
19. Rolskov Bojsen S, Räder SB, Holst AG, Kayser L, Ringsted C,
Hastrup Svendsen J, et al. The acquisition and retention of
ECG interpretation skills after a standardized web‑based ECG
tutorial‑a randomised study. BMC Med Educ 2015;15:36.
20. Pourmand A, Tanski M, Davis S, Shokoohi H, Lucas R, Zaver F,
et al. Educational technology improves ECG interpretation
of acute myocardial infarction among medical students and
emergency medicine residents. West J Emerg Med 2015;16:133‑7.
21. AlaviM, LeidnerDE. Research Commentary: Technology‑Mediated
Learning‑a Call for Greater Depth and Breadth of Research.
2001;12(1):1‑0. Information Systems; 2009.
22. Garde S, Heid J, Haag M, Bauch M, Weires T, Leven FJ, et al. Can
design principles of traditional learning theories be fulfilled by
computer‑based training systems in medicine: The example of
CAMPUS. Int J Med Inform 2007;76:124‑9.
23. Cook DA. Web‑based learning: Pros, cons and controversies. Clin
Med (Lond) 2007;7:37‑42.
24. Kaveevivitchai C, Chuengkriankrai B, Luecha Y, Thanooruk R,
Panijpan B, Ruenwongsa P. Enhancing nursing students’ skills
in vital signs assessment by using multimedia computer‑assisted
learning with integrated content of anatomy and physiology.
Nurse Educ Today 2009;29:65‑72.
25. Huang EW, Chen YJ, Yang SF, Cheng PJ, Shih CY, Yen YC. Design
and implementation of a multimedia education system for nursing
physical examination. J Taiwan Assoc Med Inform 2006;15:1‑10.
26. Ryan M, Carlton KH, Ali NS. Evaluation of traditional classroom
teaching methods versus course delivery via the world wide web.
J Nurs Educ 1999;38:272‑7.
27. Voutilainen A, Saaranen T, Sormunen M. Conventional vs.
e‑learning in nursing education: A systematic review and
meta‑analysis. Nurse Educ Today 2017;50:97‑103.
28. Perfeito JA, Forte V, Giudici R, Succi JE, Lee JM, Sigulem D.
Development and assessment of a multimedia computer
program to teach pleural drainage techniques. J Bras Pneumol
2008;34:437‑44.
29. Lee YK, Chuang CH, Wong CH, Yang CH, Shih CY. Evaluate
the efficacy of video assisted learning in ventricular fibrillation
training: A prospective randomized single‑blind study. J Taiwan
Emerg Med 2005;7:154‑62.
30. Mohammadi B, Vahedparast H, RavaniPour M, Sadeghei T.
Comparing the effects of heart dysrhythmia training through
both lecture and multimedia software approaches on the
knowledge retention of nursing students. Educ Dev Jundishapur
2015;6:115‑21.
31. Aminizadeh M, Saberinia A, Kohan S, Shokouhi I, Fagihi A,
Aminizadeh E. A comparison of virtual and traditional teaching
methods in the functional skills of paramedical technicians in
pre‑hospital emergency. Dev Steps Med Educ 2015;12:388‑98.
32. Baghaei R, Rasouli D, Rahmani A, Mohammadpour Y,
Jafarizadeh H. Effect of web‑based education on cardiac
Dysrhythmia learning in nursing student of Urmia University
of Medical Sciences. Iran J Med Educ 2012;12:240‑8.
33. Horiuchi S, Yaju Y, Koyo M, Sakyo Y, Nakayama K. Evaluation
of a web‑based graduate continuing nursing education program
in Japan: A randomized controlled trial. Nurse Educ Today
2009;29:140‑9.
34. Jeffries PR, Woolf S, Linde B. Technology‑based vs. traditional
instruction. A comparison of two methods for teaching the skill
of performing a 12‑lead ECG. Nurs Educ Perspect 2003;24:70‑4.
35. Sheikh AbuMasoudi R, Soltani MollaYaghobi N. Comparison
the effect of electronic learning and teaching based on lecture on
knowledge of nursing students about heart dysrhythmias in 2014:
A short report. J Rafsanjan Univ Med Sci 2015;14:339‑44.
36. Choules AP. The use of elearning in medical education: A review
of the current situation. Postgrad Med J 2007;83:212‑6.
37. Kim JA. The development and effectiveness of web based
continuing nurse education program. J Korean Acad Nurs Adm
2011;7:361‑75.
38. Belfry MJ, Winne PH. A review of the effectiveness of computer
assisted instruction in nursing education. Comput Nurs
1988;6:77‑85.
39. Thakore H, McMahon T. An interactive e‑tutorial in pathology.
Med Educ 2006;40:1135.
40. Chang MH, Hsu LL. Multimedia instruction: Its efficacy in nurse
electrocardiography learning. Hu Li Za Zhi 2010;57:50‑8.
41. Badanara A, Emami Sigaroudi A, Kazemnezhad‑Leyli E,
Poursheikhian M. Compare the effect of two electronic and
traditional education methods on first principles of instruction
in nursing students of Guilan University of Medical Sciences in
2016. Res Med Educ 2018;10:48‑55.
42. Chi MT, Siler SA, Jeong H, Yamauchi T, Hausmann RG. Learning
from human tutoring. Cogn Sci 2001;25:471‑533.
43. Bloom BS. The 2 sigma problem: The search for methods of
group instruction as effective as one‑to‑one tutoring. Educ Res
1984;13:4‑16.
Francês CR. Educational software applied in teaching
electrocardiogram: A systematic review. Biomed Res Int
2018;2018:8203875.
2. Raupach T, Harendza S, Anders S, Schuelper N, Brown J. How
can we improve teaching of ECG interpretation skills? Findings
from a prospective randomised trial. J Electrocardiol 2016;49:7‑12.
3. Viljoen CA, Scott Millar R, Engel ME, Shelton M, Burch V.
Is computer‑assisted instruction more effective than other
educational methods in achieving ECG competence among
medical students and residents? Protocol for a systematic review
and meta‑analysis. BMJ Open 2017;7:e018811.
4. Davies A, Vigo M, Harper S, Jay C. The visualisation of
eye‑tracking scanpaths: What can they tell us about how
clinicians view electrocardiograms? IEEE Second Workshop on
Eye Tracking and Visualization (ETVIS). In: Eye Tracking and
Visualization (ETVIS). Baltimore, MD, USA: IEEE; 2017. p. 1‑6.
5. LakK, ZareieF, HabibzadehH, MohammadpourY, RahnemoonK,
Zare H, et al. A survey on the effect of educational software
method of arrhythmias stimulator on the level of knowledge of
electrocardiograms interpretation in nurses. Iran J Crit Care Nurs
2013;6:173‑80.
6. Funk M, Fennie KP, Stephens KE, May JL, Winkler CG, Drew BJ,
et al. Association of implementation of practice standards for
electrocardiographic monitoring with nurses’ knowledge, quality
of care, and patient outcomes: Findings from the practical use of
the latest standards of electrocardiography (PULSE) trial. Circ
Cardiovasc Qual Outcomes 2017;10. pii: e003132.
7. Brooks CA, Kanyok N, O’Rourke C, Albert NM. Retention of
baseline electrocardiographic knowledge after a blended‑learning
course. Am J Crit Care 2016;25:61‑7.
8. Granero‑Molina J, Fernández‑Sola C, López‑Domene E,
Hernández‑Padilla JM, Preto LS, Castro‑Sánchez AM. Effects
of web‑based electrocardiography simulation on strategies and
learning styles. Rev Esc Enferm USP 2015;49:650‑6.
9. Omidifar N, Yamani N, Yousefi A. The effect of ECG training
workshop on medical students’ knowledge of ECG reading and
interpretation. J Strides Dev Med Educ 2007;3(2):118‑25.
10. Breen CJ, Kelly GP, Kernohan WG. ECG interpretation skill
acquisition: A review of learning, teaching and assessment.
J Electrocardiol 2019. pii: S0022‑0736(18)30641‑1.
11. Moffett J, Berezowski J, Spencer D, Lanning S. An investigation
into the factors that encourage learner participation in a large
group medical classroom. Adv Med Educ Pract 2014;5:65‑71.
12. Fent G, Gosai J, Purva M. Teaching the interpretation of
electrocardiograms: Which method is best? J Electrocardiol
2015;48:190‑3.
13. Luscombe C, Montgomery J. Exploring medical student learning
in the large group teaching environment: Examining current
practice to inform curricular development. BMC Med Educ
2016;16:184.
14. Mahler SA, Wolcott CJ, Swoboda TK, Wang H, Arnold TC.
Techniques for teaching electrocardiogram interpretation:
Self‑directed learning is less effective than a workshop or lecture.
Med Educ 2011;45:347‑53.
15. Fincher RM, Abdulla AM, Sridharan MR, Houghton JL, Henke JS.
Teaching fundamental electrocardiography to medical students:
Computer‑assisted learning compared with weekly seminars. Res
Med Educ 1987;26:197‑202.
16. Losco CD, Grant WD, Armson A, Meyer AJ, Walker BF. Effective
methods of teaching and learning in anatomy as a basic science:
A BEME systematic review: BEME guide no 44. Med Teach
2017;39:234‑43.
17. Montassier E, Hardouin JB, Segard J, Batard E, Potel G,
Planchon B, et al. E‑learning versus lecture‑based courses in ECG interpretation for undergraduate medical students: A randomized
noninferiority study. Eur J Emerg Med 2016;23:108‑13.
18. Nilsson M, Bolinder G, Held C, Johansson BL, Fors U, Ostergren J,
et al. Evaluation of a web‑based ECG‑interpretation programme
for undergraduate medical students. BMC Med Educ 2008;8:25.
19. Rolskov Bojsen S, Räder SB, Holst AG, Kayser L, Ringsted C,
Hastrup Svendsen J, et al. The acquisition and retention of
ECG interpretation skills after a standardized web‑based ECG
tutorial‑a randomised study. BMC Med Educ 2015;15:36.
20. Pourmand A, Tanski M, Davis S, Shokoohi H, Lucas R, Zaver F,
et al. Educational technology improves ECG interpretation
of acute myocardial infarction among medical students and
emergency medicine residents. West J Emerg Med 2015;16:133‑7.
21. AlaviM, LeidnerDE. Research Commentary: Technology‑Mediated
Learning‑a Call for Greater Depth and Breadth of Research.
2001;12(1):1‑0. Information Systems; 2009.
22. Garde S, Heid J, Haag M, Bauch M, Weires T, Leven FJ, et al. Can
design principles of traditional learning theories be fulfilled by
computer‑based training systems in medicine: The example of
CAMPUS. Int J Med Inform 2007;76:124‑9.
23. Cook DA. Web‑based learning: Pros, cons and controversies. Clin
Med (Lond) 2007;7:37‑42.
24. Kaveevivitchai C, Chuengkriankrai B, Luecha Y, Thanooruk R,
Panijpan B, Ruenwongsa P. Enhancing nursing students’ skills
in vital signs assessment by using multimedia computer‑assisted
learning with integrated content of anatomy and physiology.
Nurse Educ Today 2009;29:65‑72.
25. Huang EW, Chen YJ, Yang SF, Cheng PJ, Shih CY, Yen YC. Design
and implementation of a multimedia education system for nursing
physical examination. J Taiwan Assoc Med Inform 2006;15:1‑10.
26. Ryan M, Carlton KH, Ali NS. Evaluation of traditional classroom
teaching methods versus course delivery via the world wide web.
J Nurs Educ 1999;38:272‑7.
27. Voutilainen A, Saaranen T, Sormunen M. Conventional vs.
e‑learning in nursing education: A systematic review and
meta‑analysis. Nurse Educ Today 2017;50:97‑103.
28. Perfeito JA, Forte V, Giudici R, Succi JE, Lee JM, Sigulem D.
Development and assessment of a multimedia computer
program to teach pleural drainage techniques. J Bras Pneumol
2008;34:437‑44.
29. Lee YK, Chuang CH, Wong CH, Yang CH, Shih CY. Evaluate
the efficacy of video assisted learning in ventricular fibrillation
training: A prospective randomized single‑blind study. J Taiwan
Emerg Med 2005;7:154‑62.
30. Mohammadi B, Vahedparast H, RavaniPour M, Sadeghei T.
Comparing the effects of heart dysrhythmia training through
both lecture and multimedia software approaches on the
knowledge retention of nursing students. Educ Dev Jundishapur
2015;6:115‑21.
31. Aminizadeh M, Saberinia A, Kohan S, Shokouhi I, Fagihi A,
Aminizadeh E. A comparison of virtual and traditional teaching
methods in the functional skills of paramedical technicians in
pre‑hospital emergency. Dev Steps Med Educ 2015;12:388‑98.
32. Baghaei R, Rasouli D, Rahmani A, Mohammadpour Y,
Jafarizadeh H. Effect of web‑based education on cardiac
Dysrhythmia learning in nursing student of Urmia University
of Medical Sciences. Iran J Med Educ 2012;12:240‑8.
33. Horiuchi S, Yaju Y, Koyo M, Sakyo Y, Nakayama K. Evaluation
of a web‑based graduate continuing nursing education program
in Japan: A randomized controlled trial. Nurse Educ Today
2009;29:140‑9.
34. Jeffries PR, Woolf S, Linde B. Technology‑based vs. traditional
instruction. A comparison of two methods for teaching the skill
of performing a 12‑lead ECG. Nurs Educ Perspect 2003;24:70‑4.
35. Sheikh AbuMasoudi R, Soltani MollaYaghobi N. Comparison
the effect of electronic learning and teaching based on lecture on
knowledge of nursing students about heart dysrhythmias in 2014:
A short report. J Rafsanjan Univ Med Sci 2015;14:339‑44.
36. Choules AP. The use of elearning in medical education: A review
of the current situation. Postgrad Med J 2007;83:212‑6.
37. Kim JA. The development and effectiveness of web based
continuing nurse education program. J Korean Acad Nurs Adm
2011;7:361‑75.
38. Belfry MJ, Winne PH. A review of the effectiveness of computer
assisted instruction in nursing education. Comput Nurs
1988;6:77‑85.
39. Thakore H, McMahon T. An interactive e‑tutorial in pathology.
Med Educ 2006;40:1135.
40. Chang MH, Hsu LL. Multimedia instruction: Its efficacy in nurse
electrocardiography learning. Hu Li Za Zhi 2010;57:50‑8.
41. Badanara A, Emami Sigaroudi A, Kazemnezhad‑Leyli E,
Poursheikhian M. Compare the effect of two electronic and
traditional education methods on first principles of instruction
in nursing students of Guilan University of Medical Sciences in
2016. Res Med Educ 2018;10:48‑55.
42. Chi MT, Siler SA, Jeong H, Yamauchi T, Hausmann RG. Learning
from human tutoring. Cogn Sci 2001;25:471‑533.
43. Bloom BS. The 2 sigma problem: The search for methods of
group instruction as effective as one‑to‑one tutoring. Educ Res
1984;13:4‑16.
)