Introduction and Review of the Literature

The University of Hawaii Obstetrics and Gynecology residency is a four year,

post-doctoral training program for individuals planning to specialize in women’s

health. The 24 residents are evenly divided between the four progressive years of

instruction.

Each week the program hosts a “Morbidity and Mortality conference (M & M

Conference) dedicated to reviewing unexpected and unfortunate outcomes related to care

on the four primary services of low-risk obstetrics, maternal-fetal medicine, benign

gynecology and gynecologic oncology. The senior resident on each service creates a list

of patients from the previous week. The moderator selects the most "instructional" cases

and calls on the residents involved to come to the podium and present each of them. As

the presentation progresses, the moderator will often interrupt to probe their

understanding of the case by asking questions. At the end of the presentation, audience

members can ask questions as well.

A brief discussion of the case follows the presentation. Residents who are shy,

non-confrontational or lacking in knowledge-base confidence often are reticent about

participating. This reluctance to participate also makes it difficult to make formative

assessments of the learning experience for the audience as a whole.

The purpose of this project is to increase engagement and participation of the

residents who do not usually respond using a free mobile audience response application.

The assumption is that increased engagement and participation will enhance the value of

the M & M Conference as an important learning tool in the residents’ medical education.

Audience response systems (ARS) were first introduced at Stanford and Cornell

Universities in the mid 1960s and became commercially available in 1992. (Kay &

LeSage, 2009) Since the early 1990s, the use of audience response systems in higher

education, professional education, and business has grown substantially. In the past two

decades, there have been numerous studies concerning the use of audience response

systems that have indicated that this strategy has benefits in the teaching and learning

process. Some of these are: “students are more engaged in class”, students participate

with peers more…to solve problems”, and “students are more focused in class”. There is

also evidence that the use of these devices improves formative assessment and contingent

teaching. (Kay & LeSage, 2009) There is also evidence that the use of ARS provides a

more positive impact on student participation than do more traditional audience response

strategies such as surveys and note cards. (Stowell & Nelson, 2007)

There is also evidence that the use of ARS can be efficacious in medical

education; specifically in the process of delivering medical information to postgraduate

medical residents. In one study of Family Medicine Residents, the investigators

conducted a controlled crossover study and found a significant difference in the retention

of information between groups who received traditional didactic lectures, lectures with an

interactive component, and interactive lectures incorporating ARS. The investigators

concluded that “improved retention occurs with active participation in the lecture

process.” (Schackow, Chavez, Loya, & Friedman, 2004) Another study compared the

efficacy of traditional lecture style delivery of information to Obstetrics and Gynecology

Residents with interactive lecture style delivery supplemented with an audience response

system. The results of this randomized controlled trial indicated that Residents who

received the ARS interactive lecture treatment showed a pre/post test improvement

approximately ten times that of the group receiving the traditional lecture treatment.

(Pradhan, Sparano, & Ananth, 2005)

A review of the literature concerning the efficacy of ARS predominantly indicates

the value of interactive devices in promoting learning, retention, and engagement.

(Banks, 2006) (Schmidt, 2011) (Guse & Zobitz, 2011) There is also evidence that the use

of ARS to replace traditional didactic lecture delivery enhances motivation and positive

affective outcomes. (Cain, Black, & Rohr, 2009)

There exists a fairly substantial body of investigation of ARS in promoting

learning, engagement, and retention of information but almost universally, the studies

involved traditional proprietary “clicker” devices that allow for limited responses–

usually, yes/no or a, b, c, d. The development of the “smartphone” and of tablet devices

has created an opportunity to examine the use of mobile-device based applications that

are free or low-cost for users and provide a greater latitude in response possibilities.

References

Banks, D. (2006). Audience Response Systems in Higher Education: Applications and Cases. Information

Science Publishing.

Cain, J., Black, E. P., & Rohr, J. (2009). An Audience Response System Strategy to Improve Student

Motivation, Attention, and Feedback. American Journal of Pharmaceutical Education, 73(2).

Retrieved from /pmc/articles/PMC2690899/?report=abstract

Guse, D. M., & Zobitz, P. M. (2011). Validation of the Audience Response System. British Journal of

Educational Technology, 42(6), 985–991.

Hancock, T. M. (2010). Use of Audience Response Systems for Summative Assessment in Large Classes.

Australasian Journal of Educational Technology, 26(2), 226–237.

Kay, R. H., & LeSage, A. (2009). A Strategic Assessment of Audience Response Systems Used in Higher

Education. Australasian Journal of Educational Technology, 25(2), 235–249.

Pradhan, A., Sparano, D., & Ananth, C. V. (2005). The influence of an audience response system on

knowledge retention: An application to resident education. American Journal of Obstetrics and

Gynecology, 193(5), 1827–1830. doi:10.1016/j.ajog.2005.07.075

Schackow, T. E., Chavez, M., Loya, L., & Friedman, M. (2004). Audience Response System:Effecton

Learning in Family Medicine Residents. Family Medicine, 36(7).

Schmidt, B. (2011). Teaching Engineering Dynamics by Use of Peer Instruction Supported by an Audience

Response System. European Journal of Engineering Education, 36(5), 413–423.

Stowell, J. R., & Nelson, J. M. (2007). Benefits of Electronic Audience Response Systems on Student

Participation, Learning, and Emotion. Teaching of Psychology, 34(4), 253–258.

Yee, K., & Hargis, J. (n.d.). GOOGLE MODERATOR AND OTHER CLICKER ALTERNATIVES. The

Turkish Online Journal of Distance Education, 12(2), 10–13. Retrieved from

http://www.doaj.org/doaj?func=abstract&id=805035&recNo=2&toc=1&uiLanguage=en