Plain English Summary
Background and study aims
The study aims to create better evidence on the role of blended learning in course development of physical examination skills in preclinical students. It will find out whether integrating clinical investigation techniques and professional posture in a blended-learning training session will lead to a greater increase in student competence compared to a classical curriculum with lecture and case demonstrations. Competencies in the above-mentioned areas are assessed with an examination in which the student is asked to examine a patient with shoulder problems.
Who can participate?
All students of the preclinical semesters who are enrolled at the Medical Faculty of Tübingen University
What does the study involve?
Participants will be randomly allocated to either blended-learning (intervention group) or a face-to-face curriculum (control group). The blended learning intervention comprises a 1.5-hour e-learning module on professional posture and clinical examination as well as the functional anatomy of the shoulder. Next, students in the intervention group attend a 1.5-hour peer learning seminar in which they train examining their peers and give mutual feedback. Participants in the control group will receive a 1.5-hour lecture on shoulder anatomy combined with a patient demonstration by a GP. Next, students in the control group are offered 1.5 hours of free training where shoulder models are available. Partcipants take an exam after 8 weeks. The exam takes about 25 minutes. Participants are given questionnaires at the start of the study and after the exam. The questionnaires take about 15 minutes to complete.
What are the possible benefits and risks of participating?
There is no risk for the participants. A personal benefit for the participants is the learning opportunity (clinical elements for pre-clinicians). In order to compensate for any additional time expenditure, students who have participated in the study and passed the examination will receive a "go free" certificate for the curricular anatomy exam of the shoulder. Furthermore, all participants will receive two cinema vouchers.
Where is the study run from?
University of Tuebingen at the Tübingen University Hospital (Germany)
When is the study starting and how long is it expected to run for?
December 2019 to August 2021
Who is funding the study?
Faculty internal ProfilPlus funding
Who is the main contact?
Dr Roland Koch
Transfer of anatomical knowledge in the examination situation for pre-clinical medical students (TraceX): a randomized, controlled study comparing face-to-face teaching and blended learning
Preclinical medical students who have completed a blended learning unit on professional posture, clinical examination skills and basic anatomical knowledge achieve a higher competency score in a simulated shoulder examination than students who have completed the same amount of time in face-to-face learning modules.
Assessed 04/05/2020, the study does not require ethic approval (Ethics Committee of the Medical Faculty, Gartenstraße 47, 72074 Tübingen, Germany; +49 7071 29 77661; firstname.lastname@example.org), ref: 231/202BO1
Two-armed randomized observer-blinded interventional trial
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Not available in web format, please use contact details to request a participant information sheet
Effect of blended learning on a complex shoulder examination requiring professional posture, transfer of anatomical knowledge and clinical examination skills
Participants (preclinical medical students) will be randomly assigned to either blended-learning (intervention group) or a face-to-face curriculum.
The blended learning intervention comprises a 1.5-h e-learning module on professional posture and clinical examination as well as functional anatomy of the shoulder. Next, students in the intervention arm attend a 1.5-h peer learning seminar in which they train examining their peers and give mutual feedback.
Participants in the control arm will receive a 1.5 h lecture on shoulder anatomy combined with a patient demonstration by a GP. Next, students in the control arm are offered 1.5 h of free training where shoulder models are available.
Intervention and control at T2 (T0+6 weeks) run parallel and will last 2 weeks in total. They are followed by a 2-day formative exam at T3 (T0+ 8 weeks). For each participant, the exam takes about 25 minutes. In the exam, the effect of the intervention is measured. Participants are given questionnaires at allocation (T0) and after the exam (T4). The questionnaires take about 15 minutes to complete.
The randomization is provided using an open-source online randomization tool (RANDI).
Primary outcome measure
Competency in professional posture, physical examination and anatomical knowledge measured as a combined score of maximum 45 points in an examination situation with an actor patient at T3 (8 weeks)
Secondary outcome measures
A newly developed and piloted questionnaire measures the following items at T0 and T4 and uses a pseudonym to measure pre-post development in the following domains:
1. Self-assessed competency level in the three domains (professional posture, anatomical knowledge and clinical examination skills)
2. German inventory on attitudes and assessment of blended learning at T0 and T4
3. Perceived stress questionnaire (PSYINDEX) at T0 and T4
4. Technology affinity (ATI) at T0 only
5. Sociodemographic characteristics at T0 only
6. Attitudes to e-learning and ways to improve the experience, assessed using focus groups with participants at T4
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
All preclinical students aged >18 years enrolled at the Medical Faculty of the University of Tübingen
Target number of participants
80 (40 per study arm)
Participant exclusion criteria
Health status does not allow participation
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Tübingen University Hospital
Institut für Allgemeinmedizin und Interprofessionelle Versorgung Medizinische Fakultät VITA Gebäude Osianderstr. 5
Trial participating centre
Eberhard-Karls University Tübingen
Institute of Clinical Anatomy and Cell Analysis Oesterbergstrasse 3
+49 (0)7071 29 73884
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Planned publication in a high-impact peer-reviewed journal on medical education. Aside from the main article, the researchers plan to publish a study protocol and a mixed-methods evaluation of the secondary outcomes.
IPD sharing statement:
The datasets generated during and/or analysed during the current study are not expected to be made available due to privacy reasons of the participants. It can be made available upon resonable personal request. It will be saved on user-restricted, ISO27001 certified servers at UKT.
Intention to publish date
Participant level data
Not expected to be available
Basic results (scientific)