Darici Dogus, Ohlenburg Hendrik, Jürgensen Lukas, Papan Cihan, Robitzsch Anita, Missler Markus, Schneider Bertrand
Institute for Anatomy and Neurobiology, University of Münster, Münster, Germany.
Institute of Education and Student Affairs, Studienhospital Münster, University of Münster, Münster, Germany.
Med Educ. 2025 Oct;59(10):1105-1116. doi: 10.1111/medu.15725. Epub 2025 May 22.
When first introducing medical procedures, instructors must decide how much of their limited time must be allocated between modelling (demonstrate and explain) and coaching (scaffold and support) students. Given the time constraints in clinical routine, it is currently unknown which relative proportion of modelling versus coaching is more efficient for procedural learning.
We randomly assigned 73 students without prior knowledge to either an extended modelling (EM) or an extended coaching (EC) group for an emergency sonography training. In the EM group, medical teachers demonstrated a routine examination explaining their thought process, while also providing some coaching. In the EC group, students trained more independently with consistent teacher support, with less emphasis on modelling. We used dual mobile eye-tracking and voice recording to objectify the teacher-student interactions and applied a comprehensive assessment to understand which learning domains improved under which condition.
On post-tests, the EC group outperformed the EM group by 12% in interpreting dynamic sonographic imagery (p = 0.014). They completed the ultrasound examinations 7% faster (p = 0.050). There was no statistical difference between the two groups in interpreting static sonographic imagery (p = 0.322) nor in practical scores (p = 0.062). Contrary to expectations, there were no differences between the groups in terms of eye movement metrics that explained the performance effects. However, two behavioural variables were positively related with learning outcomes across both groups: the percentage of joint visual attention between teacher and student (β = 0.316, p < 0.001) and the number of words spoken during the training (β = 0.175, p = 0.004).
This study provides empirical evidence that EC may be particularly effective when introducing new procedural medical skills. In learning complex procedures, direct sensorimotor experience with guided support appears more advantageous than extended observation. These findings suggest that medical educators should give students more opportunities for supervised hands-on practice rather than relying primarily on demonstration-based teaching.
在首次介绍医疗程序时，教师必须决定如何在模拟（演示和解释）和指导（搭建支架和提供支持）学生之间分配他们有限的时间。鉴于临床常规中的时间限制，目前尚不清楚模拟与指导的相对比例对程序学习而言哪种更有效。
我们将73名没有先验知识的学生随机分配到扩展模拟（EM）组或扩展指导（EC）组进行急诊超声检查培训。在EM组中，医学教师演示常规检查并解释他们的思维过程，同时也提供一些指导。在EC组中，学生在教师持续支持下更独立地进行培训，较少强调模拟。我们使用双移动眼动追踪和语音记录来客观化师生互动，并进行全面评估以了解在何种条件下哪些学习领域得到了改善。
在后期测试中，EC组在解读动态超声图像方面比EM组高出12%（p = 0.014）。他们完成超声检查的速度快7%（p = 0.050）。两组在解读静态超声图像方面（p = 0.322）以及实践得分方面（p = 0.062）没有统计学差异。与预期相反，两组在解释表现效果的眼动指标方面没有差异。然而，有两个行为变量与两组的学习成果呈正相关：师生共同视觉关注的百分比（β = 0.316，p < 0.001）以及培训期间说话的字数（β = 0.175，p = 0.004）。
本研究提供了实证证据，表明在引入新的程序性医疗技能时，扩展指导可能特别有效。在学习复杂程序时，有引导支持的直接感觉运动体验似乎比扩展观察更具优势。这些发现表明，医学教育工作者应给予学生更多监督下的实践机会，而不是主要依赖基于演示的教学。
