Abstract Background/Introduction Improving uptake and accessibility of echocardiography necessitates more efficient training. Current training programmes are focused around expert mentorship, clinical practicals, and lectures. All of these are resource-intensive, and difficult to scale. Research into the way humans learn has consistently found that techniques such as spaced testing and interleaving of subjects, deliver superior retention - even of complex topics. These can be most easily and cost-effectively delivered online. Purpose To test how quickly students learn using an online platform, utilising contemporary teaching methods, made freely available to individuals within the NHS. Methods We designed our platform to facilitate interactive questioning of medical images, and performing interpretive and measurement tasks within echocardiography (Picture 1). We piloted it in two phases. In phase one, to establish the acquisition of knowledge and skills without our platform, we recruited non-cardiology trainee doctors with daily access to a handheld cardiac ultrasound device, but without formal teaching. They received 5 consecutive 21-question quizzes, delivered by email and text at weekly intervals. Each quiz was balanced to include knowledge questions, such as anatomy identification; and interpretive questions, including grading ventricular function, chamber size, and valve disease severity. No feedback was provided. To provide a benchmark, 3 experts undertook the same quizzes. In phase two, we opened up to anyone interested in learning echocardiography. In addition to the optimised quizzes, these participants received daily 21-question training modules. Results 7 participants enrolled in phase one. They showed no improvement in test performance across the 5 weeks (+2% per week, 95% CI -2% to 6%, p=0.33). Questions which proved to be properly constructed (scores of 100% for experts) yet "too easy" (scores of 90% or higher for learners) were eliminated, and not used for the testing phase. 12 participants enrolled in phase two. All worked through the modules at their own pace (of those who did all 19 quizzes, time taken ranged from 6.6 to 15.6 weeks; median 14.3 weeks). Participants showed significant improvement over time (+11% per week, 95% CI, p<0.001). Those who took the quizzes later into any training programmes they were undertaking in parallel did not outperform those who took them earlier (p=0.89). For LV function, participants showed little improvement over time (+9% per week, 95% CI -13% to +51%, p=0.23); but after undertaking a 5-quiz module on LV function, test scores increased 36% (95% CI 0% to 74%, p=0.05) from the previous week. Conclusions Our findings suggest that key skills in echocardiography can be efficiently learnt outside of the lecture theatre or clinical environment. Furthermore, precious time spent in the echo lab or on clinical placement might be more efficiently utilised by completing our online modules ahead of time.
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