Development Strategies in Medical Education

Introduction
Micro-learning is defined as a key method in faculty development programs. Micro-learning focuses on tailoring education to the needs of learners. It refers to small learning units interconnected with small content, such as brief learning activities and short sections. Also, the learning content is delivered using the principles of collaborative learning and media design models, such as the process-based approach. The learning process is fabricated in short sessions of 10-15 minutes. A micro-learning course consists of short sessions such as an introduction, learning activity (eg, exercise, problem-solving, and assignment), and conclusion (discussion and feedback). In essence, micro-learning is based on discovering concepts and problem-solving, while macro-learning centers on the perception of the study subject. The present study assessed the effect of micro-learning training within the faculty development program of clinical education on the learning of clinical teachers compared to the classic virtual training method.

Methods
This quasi-experimental study was conducted at Shahid Sadoughi University of Medical Sciences, Yazd City, Iran. This study was carried out in two phases: designing an educational program based on the micro-learning approach entitled “Effective Clinical Education Techniques” and implementing the asynchronous virtual empowerment program and program evaluation. 
The educational objective was to develop teaching skills in the process of clinical education of faculty members. The electronic micro-learning content included design, production, implementation, and evaluation. In the first phases, the educational design was carried out, and the objectives of the educational sessions were defined. The teaching method was virtual and asynchronous. For the intervention group, the principles of micro-learning were used to develop the e-content of the training course. 
Micro-learning principles, including the shortness of the content, dividing it into small units, using images, and descriptive and explicit content, were used to produce the e-content. The micro-learning content included key points of clinical education and visual schematics. Nine educational contents were developed in this regard. The micro-learning content explained the steps and technical principles of clinical education and assessment methods. Images and infographics were used so that the participants could better understand the educational design process, teaching-learning methods, and evaluation methods in clinical education. I-spring served as the platform to design educational content. Each content, including audio and video, was prepared and presented briefly (10 minutes). Educational content related to educational principles in clinical education included 1) morning reports, 2) simulation-based training, 3) clinical rounds, 4) out-patient education, and 5) the case-based learning method and virtual education and blended learning. In addition, clinical evaluation methods based on the Miller pyramid were organized, including evaluation in the levels of “knows” and “knows how” (written examination, reasoning, and decision-making examination), patient management problems (eg, key feature and modified essay), the level of “show” (eg, simulated examination, OSCE), and “does” (eg, Mini-CEX and DOPS). The validity of micro-learning content was approved from the viewpoints of experts in health professions education and clinical educators (n=15 experts).
In the second phase, the faculty development program of clinical education was implemented. The participants were clinical teachers (n=73). The participants in the intervention accessed the micro-learning e-content through the university’s learning management system (LMS). The training course lasted 5 months. The opportunity to exchange opinions regarding educational topics was provided in a virtual forum.
In contrast, the clinical teachers in the control group used the training program in an asynchronous virtual format through classic electronic content (video-recorded).

Assessment
The participants’ satisfaction and learning were evaluated after the completion of the training. The satisfaction of the participants was assessed with a 9-item questionnaire. Also, the participants’ learning was evaluated using scenario-based questions (modified assay) (10 questions). The face and content validity of the questionnaires were confirmed by experts. Data were analyzed using descriptive statistics (mean and standard deviation) and analytical statistics (the student t test).

Results
In this study, 35 clinical teachers participated in the intervention group and 38 in the control group. All participants held the position of assistant professors with a Mean±SD age of 36±3 years. The mean scores in the intervention group were reported as 45±6 before training and 89±8 after training. The results showed a significant difference between the scores before and after the training in the intervention group (P=0.0001). In the control group, pretest scores were 44±8, and posttest scores were 76±14. The results showed that the difference in the learning scores of the participants in the intervention and control groups was significant (P=0.0001). The results showed that the satisfaction of participants in the intervention group (95±13) and the control group (86±9) was reported at the desired level, and the satisfaction of learners in the intervention group was significantly higher than the control group (P =0.009).

Conclusion
The results showed that implementing a micro-learning approach in faculty development improved the learning and satisfaction of clinical teachers. This finding suggests that integrating micro-learning principles in empowerment programs of the universities of medical sciences is advisable.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee in Human Research, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. (Code: IR.SSU.REC.1400.206). 

Funding
This project has been approved in the Research and Technology Department of Shahid Sadoughi University of Medical Sciences, Yazd, and it has been carried out with the financial support of the Technology Research Department of Shahid Sadoughi University of Medical Sciences, Yazd (Grand No.: 13654).

Authors' contributions
The authors contributed equally to preparing this paper.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
Researchers consider it necessary to appreciate Shahid Sadoughi University of Medical Sciences for its financial support and the assistance and cooperation of the management participating in this study. 
 

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