Integrated e-Learning for Shoulder Anatomy and Clinical Examination Skills in First-Year Medical Students: Randomized Controlled Trial.

Background: Applying functional anatomy to clinical examination techniques in shoulder examination is challenging for physicians at all learning stages. Anatomy teaching has shifted toward a more function-oriented approach and has increasingly incorporated e-learning. There is limited evidence on whether the integrated teaching of professionalism, clinical examination technique, and functional anatomy via e-learning is effective. Objective: This study aimed to investigate the impact of an integrated blended learning course on the ability of first-year medical students to perform a shoulder examination on healthy volunteers. Methods: Based on Kolb's experiential learning theory, we designed a course on shoulder anatomy and clinical examination techniques that integrates preclinical and clinical content across all 4 stages of Kolb's learning cycle. The study is a randomized, observer-blinded controlled trial involving first-year medical students who are assigned to one of two groups. Both groups participated in blended learning courses; however, the intervention group's course combined clinical examination, anatomy, and professional behavior and included a peer-assisted practice session as well as a flipped classroom seminar. The control group's course combined an online lecture with self-study and self-examination. After completing the course, participants uploaded a video of their shoulder examination. The videos were scored by 2 blinded raters using a standardized examination checklist with a total score of 40. Results: Thirty-eight medical students were included from the 80 participants needed based on the power calculation. Seventeen intervention and 14 control students completed the 3-week study. The intervention group students scored a mean of 34.71 (SD 1.99). The control students scored a mean of 29.43 (SD 5.13). The difference of means was 5.3 points and proved to be statistically significant (P<.001; 2-sided Mann-Whitney U test). Conclusions: The study shows that anatomy, professional behavior, and clinical examination skills can also be taught in an integrated blended learning approach. For first-year medical students, this approach proved more effective than online lectures and self-study.