How to Prepare Obstetric Interns for Cardiotocography Interpretation?

Article Information

S P C Verkleij1,*, I M de Graaf1, P C A M Bakker1

1Obstetric and Gynecology department, AmsterdamUMC, The Netherlands

*Corresponding Author: S P C Verkleij, Meibergdreef 9 (H4-250), NL-1105 AZ Amsterdam, Netherlands.

Received: 14 September 2022; Accepted: 27 September 2022; Published: xx December 2022

Citation: S P C Verkleij, I M de Graaf, P C A M Bakker. How to prepare obstetric interns for cardiotocography interpretation? Obstetrics and Gynecology Research 5 (2022): 319-324.

View / Download Pdf Share at Facebook


Background/Introduction: Cardiotocography (CTG) is an important obstetric tool to assess fetal wellbeing. Interns are exposed to a lot of fetal heart traces during their internship. Knowledge on this is gained by (undergraduate) teaching and by working with clinicians. With this prospective cohort study we aim to investigate if introducing a CTG e-learning makes interns feel better prepared and more competent in interpreting CTG.

Methods: We evaluated a 1-hour CTG e-learning containing basic principles and interpretation skills. We used anonymous evaluation questionnaires. The answers of the questionnaires were entered in and examined with IBM® SPSS® statistics version 26. Results: Students with access to the CTG e-learning felt better prepared (p=0.001), more competent (p=0.001) and were more satisfied with the education (p=0.000). Students with or without access to the e-learning scored the same on the knowledge test (p=0.504).

Conclusions: Providing a CTG e-learning at the start of the obstetrics/gynecology internship makes students feel more prepared and more competent on interpreting CTG’s. They are satisfied with the education.


Cardiotocography; e-learning; medical student; intern; competence

Cardiotocography articles Cardiotocography Research articles Cardiotocography review articles Cardiotocography PubMed articles Cardiotocography PubMed Central articles Cardiotocography 2023 articles Cardiotocography 2024 articles Cardiotocography Scopus articles Cardiotocography impact factor journals Cardiotocography Scopus journals Cardiotocography PubMed journals Cardiotocography medical journals Cardiotocography free journals Cardiotocography best journals Cardiotocography top journals Cardiotocography free medical journals Cardiotocography famous journals Cardiotocography Google Scholar indexed journals e-learning articles e-learning Research articles e-learning review articles e-learning PubMed articles e-learning PubMed Central articles e-learning 2023 articles e-learning 2024 articles e-learning Scopus articles e-learning impact factor journals e-learning Scopus journals e-learning PubMed journals e-learning medical journals e-learning free journals e-learning best journals e-learning top journals e-learning free medical journals e-learning famous journals e-learning Google Scholar indexed journals medical student articles medical student Research articles medical student review articles medical student PubMed articles medical student PubMed Central articles medical student 2023 articles medical student 2024 articles medical student Scopus articles medical student impact factor journals medical student Scopus journals medical student PubMed journals medical student medical journals medical student free journals medical student best journals medical student top journals medical student free medical journals medical student famous journals medical student Google Scholar indexed journals intern articles intern Research articles intern review articles intern PubMed articles intern PubMed Central articles intern 2023 articles intern 2024 articles intern Scopus articles intern impact factor journals intern Scopus journals intern PubMed journals intern medical journals intern free journals intern best journals intern top journals intern free medical journals intern famous journals intern Google Scholar indexed journals competence articles competence Research articles competence review articles competence PubMed articles competence PubMed Central articles competence 2023 articles competence 2024 articles competence Scopus articles competence impact factor journals competence Scopus journals competence PubMed journals competence medical journals competence free journals competence best journals competence top journals competence free medical journals competence famous journals competence Google Scholar indexed journals Fetal Heart Rate articles Fetal Heart Rate Research articles Fetal Heart Rate review articles Fetal Heart Rate PubMed articles Fetal Heart Rate PubMed Central articles Fetal Heart Rate 2023 articles Fetal Heart Rate 2024 articles Fetal Heart Rate Scopus articles Fetal Heart Rate impact factor journals Fetal Heart Rate Scopus journals Fetal Heart Rate PubMed journals Fetal Heart Rate medical journals Fetal Heart Rate free journals Fetal Heart Rate best journals Fetal Heart Rate top journals Fetal Heart Rate free medical journals Fetal Heart Rate famous journals Fetal Heart Rate Google Scholar indexed journals gynaecology articles gynaecology Research articles gynaecology review articles gynaecology PubMed articles gynaecology PubMed Central articles gynaecology 2023 articles gynaecology 2024 articles gynaecology Scopus articles gynaecology impact factor journals gynaecology Scopus journals gynaecology PubMed journals gynaecology medical journals gynaecology free journals gynaecology best journals gynaecology top journals gynaecology free medical journals gynaecology famous journals gynaecology Google Scholar indexed journals obstetrics articles obstetrics Research articles obstetrics review articles obstetrics PubMed articles obstetrics PubMed Central articles obstetrics 2023 articles obstetrics 2024 articles obstetrics Scopus articles obstetrics impact factor journals obstetrics Scopus journals obstetrics PubMed journals obstetrics medical journals obstetrics free journals obstetrics best journals obstetrics top journals obstetrics free medical journals obstetrics famous journals obstetrics Google Scholar indexed journals midwives articles midwives Research articles midwives review articles midwives PubMed articles midwives PubMed Central articles midwives 2023 articles midwives 2024 articles midwives Scopus articles midwives impact factor journals midwives Scopus journals midwives PubMed journals midwives medical journals midwives free journals midwives best journals midwives top journals midwives free medical journals midwives famous journals midwives Google Scholar indexed journals Maternal articles Maternal Research articles Maternal review articles Maternal PubMed articles Maternal PubMed Central articles Maternal 2023 articles Maternal 2024 articles Maternal Scopus articles Maternal impact factor journals Maternal Scopus journals Maternal PubMed journals Maternal medical journals Maternal free journals Maternal best journals Maternal top journals Maternal free medical journals Maternal famous journals Maternal Google Scholar indexed journals

Article Details

List of abbreviations

CTG = Cardiotocography; EFM = Electronic Fetal Heart Rate Monitoring; FHR = Fetal Heart Rate


When interns start a new internship, they are confronted with a lot of new information, techniques and knowledge. One of these techniques in the gynaecology/obstetrics internship is electronic fetal heart rate monitoring (EFM) by means of a cardiotocograph (CTG). This is a ubiquitous obstetric tool to assess fetal condition in relation to uterine contractions. The main goal of fetal heart rate (FHR) monitoring is to detect fetal hypoxia intrapartum, so that a well-timed and appropriate intervention can be started to improve perinatal outcome. Interpretation of CTG is done by professionals, at least every hour during labour.

Students are exposed with many different FHR traces during their obstetric internship. They acquired some basic knowledge during lectures in their undergraduate years in the bachelor phase of their medical education. Interns acquire and expand their knowledge by reading books, protocols and working with physicians and clinical midwives. However, gaining knowledge during internships depends on how the student learns, the clinicians time and willingness to teach[1,2]. Students need basic knowledge on EFM to make the desired step towards clinical reasoning. An e-learning, providing the basic principles and interpretation skills on EFM, is a good and easily accessible resource for teaching the basics. E-learnings can stimulate an active learning culture[3]. It is a part of the blended learning strategy together with the clinical experience of an internship. An e-learning offers the students self-directed learning with control over learning pace, time and content. They can check and recheck the information whenever and how often they want.

A few articles have been published on CTG e-learnings for students. The studies evaluated the reactions of the students on the learning product and they evaluated if participants improved their knowledge. The e-learnings were judged useful and have positive effect on knowledge[4-8]. None of these articles evaluated the effects of a CTG e-learning on competence of CTG during an internship.

This prospective cohort study aims to investigate if providing a CTG e-learning at the beginning of the internship has a positive influence on interns CTG competence and feeling of readiness. By means of a questionnaire and knowledge test, this study aims to evaluate if students feel better prepared and more competent in the context of EFM during their internship. Methods

We developed a 1-hour CTG e-learning on the basic principles and interpretation skills of EFM. The e-learning is hosted on the digital learning environment of the University of Amsterdam. The learning objectives of the e-learning are: explain the physiological backgrounds of fetal heart rate, structurally assess a CTG and recognize an abnormal fetal heart rate pattern. We used different learning theories to stimulate active learning[9-11].

We used the behaviorist theory and the constructivism theory. The e-learning is divided in two parts. The first part of the e- learning consists information on the physiological basis of fetal oxygenation, the technique behind CTG and interpretation and classification of fetal heart rate (including baseline frequency, variability, accelerations and decelerations). This material is broken down in smaller pieces with multiple choice questions for revision. The second part of the e-learning consists of

CTG’s where students have the opportunity to apply their gained knowledge and practice their interpretation skills. Participants were fifth-year medical students during their 8-week gynecological and obstetric internship at the Amsterdam UMC location AMC. Participation was completely voluntarily and anonymous. This is a pre- and post-implementation study. We compared two groups: a non-intervention group consisting of students with no availability to the e-learning versus an intervention group with students having unlimited access to the e-learning from the start of their internship. Besides availability of the e-learning for the intervention group, there were no other changes in the CTG education program. The standard CTG education is a short introduction of 10 minutes on EFM at the start of their internship. There is no other structural CTG education, besides lectures during their undergraduate years in the bachelor phase of their medical education. Evaluation questionnaires (see table 1) and a knowledge test (see supplementary information) were used for evaluation. All students were asked to participate in the evaluation and fill in the questionnaire and knowledge test at the end of their internship.

IBM® SPSS® statistics version 26 was used for statistical analysis. The free text data was examined and coded by two authors (S.V. and I.G.). The following statistical test were performed: Pearson’s Chi-square, Mann Whitney U Fisher’s exact, and T-test.

For the questionnaire we used a 10-point Likert scale because it gives more precision and students are well acquainted with this scale, as they are assessed on this scale throughout their studies. In the statistical analyses we used cut off value of 7, as students are graded above 7 when they are function normally during their internship.

Answer possibilities

Where did you acquire your knowledge of CTG? (multiple answers possible)

· Physician/gynecologist

· Bachelor study in medicine

· Book

· Introduction day of the internship

· Fellow intern

· Searched online

· Hospital’s protocol

· Other, namely ……

I’ve made the CTG e-learning$


I think the e-learning is educational and why?$


I felt capable to interpret CTGs during my first shift at the obstetric department.


During the internship I felt like I acquired enough knowledge to interpret a CTG.


I felt like I had sufficient CTG education during my internship.


I can explain the interpretation of an CTG to a fellow intern.


I can explain the interpretation to a patient.


I dare to call a resident/gynaecologists about a CTG.


I feel capable/competent interpreting a CTG.


$ only asked in the intervention group

* a ten-point likert scale (1= completely disagree to 10 completely agree)

Table 1: Questionnaire

Ethical approval and consent to participate

The study was deemed exempt approval by the ethical commission of the Amsterdam UMC (‘Medische Ethische Toetsingscommissie’), reference number W21_060. They also waived the need for written informed consent, as it concerned a completely anonymous evaluation.


A total of 92 students from both groups, were asked to fill in the questionnaire and knowledge test, of which 80 returned their answers. This resulted in an 87% response rate.

The non-intervention group had a response rate of 94%: 44 of the 47 questionnaires were returned. Thirty-six of the 45 questionnaires returned in the intervention group (response rate 80%).

Besides the e-learning, students of both groups obtained knowledge and information in the same manner during their internship, (see table 2). Most students obtained knowledge from clinicians (70.0%) or they searched online (58.8%). Students indicated not to have obtained knowledge from fellow interns (2%) and only a few students recalled knowledge from their bachelor phase of their education (6.3%).

Not all students in the intervention group made use of the e-learning; 26 of the 36 (72.2%) students who returned their questionnaire made use of the e-learning. Reasons why they didn’t used the e-learning were: the intern didn’t know the e- learning existed (n=3), the intern made another e-learning (n=3), the intern couldn’t find the e-learning (n=1), the intern experienced technical issues (n=1), the e-learning wasn’t obligated (n=1), the intern rated his/her knowledge as sufficient without the e-learning (n=1).


Total (n=80)

Non-intervention group (n=44)

Intervention group (n=36)


Physician/midwive, n(%)

56 (70.0)

33 (75.0)

23 (63.9)


Bachelor of Medicine, n(%)

5 (6.3)

2 (4.5)

3 (8.3)


Book, n(%)

12 (15.0)

10 (22.7)

2 (5.6)


Introduction-day, n(%)

37 (46.3)

21 (47.7)

16 (44.4)


Fellow intern, n (%)

2 (2.5)

2 (4.5)

0 (0.0)


Searched online, n (%)

47 (58.8)

28 (63.6)

19 (52.8)


Hospital’s protocol, n (%)

24 (30.0)

15 (34.1)

9 (25.0)


E-learning, n (%)

26 (32.5)

0 (0.0)

26 (72.2)


$ = Pearson chi-quare

* = Fishers exact

Table 2: Obtainment CTG knowledge

The students in the intervention group preferred the e-learning. They thought it was educational with clear explanation and they liked the opportunity to practice classification of a CTG with immediate feedback. The also felt better prepared (p=0.001), experienced enough CTG education during their internship (p=0.005) and felt more competent about using CTG (p=0.001), (see table 3). There was no difference in feeling competent in explaining a patient about the CTG or asking a physician.


Total (n=80)

Non-intervention group (n=44)

Intervention group (n=36)


I felt capable to interpret CTGs during my first shift at the obstetric department, n (%)

39 (48.8)

14 (31.8)

25 (69.4)


During the internship I felt like I

acquired enough knowledge to interpret an CTG, n (%)

67/79 (84.8)

32/43 (74.4)

35 (97.2)


I felt like I had sufficient CTG education during my internship, n (%)

33/79 (42.3)

9/43 (21.4)

24 (66.7)


I can explain the interpretation of an CTG to a fellow intern, n (%)

70/79 (88.6)

35/43 (81.4)

35 (97.2)


I can explain the interpretation to a patient, n (%)

69/79 (87.3)

36/43 (83.7)

33 (91.7)


I dare to cal/ask a resident/gynecologists about a CTG, n (%)

70/79 (88.6)

36/43 (83.7)

34 (94.4)


I feel capable/competent interpreting an CTG, n (%)

65/79 (82.3)

30/43 (69.8)

35 (97.2)


$ = Pearson chi-quare

* = Fishers exact

Table 3: Questionnaire results, Likert Scale cut off ≥7

Both groups made the same knowledge test. There was no difference in test scores between the groups. (p=0.76). The mean score of the non-intervention group was 7.68 (standard deviation ±1.68 and mean score of the intervention group was 7.56 (standard deviation ±1.97). The highest possible score was 14.


Results of this pre- and post-implementation study indicate that interns with unlimited access to a CTG e-learning feel better prepared and more competent in interpreting CTGs than interns with no availability to the e-learning. We found a significant difference in the educational experience: more students with access to the e-learning reported to experience sufficient education.

Other studies were CTG e-learning was introduced were also successful. Catanzarite et al. introduced a computer aided instructional system for medical students during their internship. Students commented the system as a valuable teaching aid and recommended to keep it in the curriculum[4]. The studies other studies evaluated also knowledge and the students with extended teaching scored significantly better. Keegan et al. added computer assisted learning to traditional reading assignment. And Wilson et al. compared computer assisted learning alone to computer assisted learning with additional tuition (lecture) in two articles. The students with most extended teaching in these articles scored significant better on knowledge tests. The students were also satisfied and judged the computer assisted learning as usefull[5,7,8].

Where these other studies found better results on knowledge test in the group with extended teaching, this study had the unexpected result of equal scores on the knowledge test in both groups. Not all our participants made use of the e-learning. But even when comparing the students who didn’t used the e-learning (n=54) and who did use the e-learning (n=27), there were also no significant difference in test scores (9.36±2.30 standard deviation vs. 10.02±2.08 standard deviation, p=0.220). There was no data collected to explain the equal scores on knowledge test. The information/answers on the questions in the test, were all in the e-learning. There are different hypotheses for possible explanation of the equal results on the knowledge test. The obstetric weeks were at the beginning of their eight-week internship, this is the period where they used the e- learning and their knowledge. Possible they forgot part of information given by the e-learning at the end of their internship, when they made the test. Another explanation: the students without the e-learning acquired the same knowledge in other ways (clinicians, books or protocols) just as they indicated in the questionnaire, (see table 2).

However, the main goal of this study was getting students feeling better prepared and more competent in interpreting CTG’s. Our students, with access to the e-learning, self-assessed feeling more prepared and competent in interpreting CTG’s. These results are in agreement with other studies on self-reported competence after e-learning. Iqbal et al. added an e-learning to a one-time live demonstration of a dental procedure. The dental students felt more competent in performing the skill-based procedure[12]. McGann et al. evaluated an e-learning for basic surgical skills for medical students. They found a significant increase in average self-reported confidence on knot tying and suturing[13]. These results are not only found for students but also for health care professionals in general. Meiser et al. evaluated an e-learning on communication breast and ovarian cancer patients about genetic testing. The oncology professionals reported higher self-rated competence in communication with patients about genetic testing[14]. Berg et al. performed a systematic review on online communication skills training on cancer and palliative care for health care professionals. Learners self-assessed improved confidence on communication[15]. This study has strengths and limitations. A strength of this study is the response rate. The average response rate of 87% has to be considered very good[16,17]. Another strength is the implementation and evaluation of a straightforward intervention. It is very easy for other hospitals and departments to use the results in the development and evaluation of their current and future education.

A limitation of this study is the relatively small sample size. This can result in a type II error; failure to reject a null hypothesis that is actually false. However, this is the first study to perform evaluation in terms of feeling better prepared, more competent and experiencing sufficient education in context of CTG during their internship. Therefore, it was not possible to calculate a sample size. Given the high response rate, there is a low chance on selection bias.

Another limitation is that this study didn’t evaluate personal CTG education given during the internship by clinicians. Hypothetically, there could be a difference in education by the various clinicians. It is almost impossible to investigate this and to correct for this. However, the internship didn’t differ between the intervention and non-intervention groups and there is a great willingness within our department to teach students. Since the students in the non-intervention and intervention group had equal scores in the knowledge test, we believe that the education in the obstetric department by clinicians didn’t differ between the groups and didn’t influence the results.

A last limitation; this study didn’t compare an e-learning with another teaching strategy, for example a lecture. Other research isn’t clear if e-learning is the best way to educate. Studies comparing different teaching strategies reporting on knowledge have contradictory results for e-learnings. Murray et al. compared a CTG e-learning versus a CTG lecture with the same content. All nursing students improved their test scores. Lecture time (235 minutes) was significantly longer than time spent on the e-learning (132,5 minutes)[6]. Golchai et al. found better test scores in e-learning versus lecture in a histology course [18]. Contrary, Pourghanznein et al. found lower test scores for e-learning vs lecture in nursing education[19]. There aren’t any publication on comparing different teaching strategies and students feeling better prepared and more competent. There are some studies about student confidence. Davies et al. compared e-learning versus near-peer teaching in electrocardiogram education for medical students. The students in both groups increased their confidence in electrocardiogram interpretation[20]. Nathan et al. compared a virtual classroom, a non-interactive video and face-to-face teaching in basic surgical skills for medical students. Suturing confidence improved in all three groups[21].

This study evaluated in the same range as self-reported confidence. Our-learning made students feel more prepared and feel more competent in interpreting CTGs. The e-learning gives the students flexibility; they can learn at their own pace and they can repeat the e-learning as often as they want. It provides them basic knowledge to build on during their internship. The e- learning did not replace the support and expertise from the clinicians during their internship. Our participating students indicated to obtained knowledge from clinicians during their internship, regardless of having access to the e-learning. Students experience the teachers’ expertise as an important part for the acquisition of knowledge, skills and competences[22]. Providing an e-learning gives students the possibility to learn the way they can learn most successfully: learning in different ways, with and without clinicians. Just as Seltz et al. concluded in their qualitative study. Students learned different depending on the presence or absence of an attending physician at ward rounds[23].

The study findings regarding feeling prepared and competent in interpreting CTG’s after introducing a 1-hour e-learning are very positive. The results are accessible for the development and evaluation of future education. Future research should focus on changing workplace learning and alignment with an e-learning, to optimize students’ learning, using of skills, confidence and satisfaction[24]. It is very easy for other hospitals and departments to use the results of this study in the development and evaluation of their current and future education.


Providing an e-learning on the basic principles and interpretation skills of EFM at the start of the obstetrics/gynecology internship makes students feel more prepared and more competent on interpreting CTG’s. They are more satisfied with the education during their internship. We judge the implementation of the e-learning, which made the clinical experience with CTG of our students better, as successful. We recommend other hospitals and departments to use these results in the development and evaluation of their education.


Ethical approval and consent to participate

The study was deemed exempt approval by the ethical commission of the Amsterdam UMC (‘Medische Ethische Toetsingscommissie’), reference number W21_060. They also waived the need for written informed consent, as it concerned a completely anonymous evaluation. We followed the principles outlined in the Declaration of Helsinki. We didn’t register any personal information. Students were given information about the purpose of the evaluation. If they wanted to participate, they filled in the questionnaire voluntarily.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interest

The authors declare that they have no competing interests.


There was no funding for this research.

Authors’ contribution

Authors S.V. and I.G. had major contribution in all stages of the study: setting up the evaluation, performing the evaluation, analyzing and interpreting the data and writing the manuscript. Author P.B. had major contributing in interpreting the data and writing the manuscript.


  1. Haferbecker D, Fakeye O, Medina S P, et , Perceptions of educational experience and inpatient workload among pediatric residents. Hosp Pediatr. 2013; 3(3): 276-284.
  2. Wingo M T, Halvorsen A J, Beckman T J, et , Associations between attending physician workload, teaching effectiveness, and patient safety. Journal of Hospital Medicine. 2016; 11(3): 169-173.
  3. Hošková-Mayerová Š, Rosická E-Learning Pros and Cons: Active Learning Culture? Procedia - Social and Behavioral Sciences. 2015; 191: 958-962.
  4. Catanzarite V FMTUTOR: a computer-aided instructional system for teaching fetal monitor interpretation. Am J Obstet Gynecol. 1987;156(5):1045-1048.
  5. Keegan R D, Oliver M C, Stanfill T J, et al., Use of a Mobile Device Simulation as a Preclass Active Learning Exercise. J Nurs 2016; 55(1): 56-59.
  6. Murray M L, Higgins Computer versus lecture: strategies for teaching fetal monitoring. J Perinatol. 1996; 16(1):15-19.
  7. Wilson T, Mires G A comparison of performance by medical and midwifery students in multiprofessional teaching. Med Educ. 2000; 34(9): 744-746.
  8. Wilson T, Mires G An investigation of the effectiveness of computer-assisted learning (CAL) for medical and midwifery students. Interactive Multimedia Electronic Journal of Computer - Enhanced Learning. 2001; 1(3).
  9. Kay D, Kibble J. Learning theories 101: application to everyday teaching and scholarship. Adv Physiol Educ. 2016; 40(1): 17-25.
  10. Pange A, Pange J. Is E-learning based on learning theories? A literature review. World Academy of Science, Engineering and Technology. 2011; 80(1): 62-66.
  11. Moedritscher F. e-Learning Theories in Practice: A Comparison of three Methods. Journal of Universal Science and Technology of Learning (JUSTL). 2006; 1(1): 3-18.
  12. Iqbal A, Ganji K K, Khattak O, et al., Enhancement of Skill Competencies in Operative Dentistry Using Procedure- Specific Educational Videos (E-Learning Tools) Post-COVID-19 Era—A Randomized Controlled Trial. International Journal of Environmental Research and Public Health. 2022; 19(7): 4135-4138.
  13. McGann K C, Melnyk R, Saba P, et al., Implementation of an E-Learning Academic Elective for Hands-On Basic Surgical Skills to Supplement Medical School Surgical Education. J Surg 2021; 78(4): 1164-1174.
  14. Meiser B, Woodward P, Gleeson M, et al. Pilot study of an online training program to increase genetic literacy and communication skills in oncology healthcare professionals discussing BRCA1/2 genetic testing with breast and ovarian cancer Familial Cancer. 2022; 21(2): 157-166.
  15. Berg M N, Ngune I, Schofield P, et al., Effectiveness of online communication skills training for cancer and palliative care health professionals: A systematic Psychooncology. 2021; 30(9): 1405-1419.
  16. Baruch Y, Response Rate in Academic Studies-A Comparative Analysis. Human 1999; 52(4): 421-438.
  17. Fincham J E. Response Rates and Responsiveness for Surveys, Standards, and the <em>Journal</em>. American Journal of Pharmaceutical Education. 2008; 72(2): 43-46.
  18. Golchai B, Nazari N, Hassani F, et , Computer-based E-teaching(Virtual Medical Teaching) or Traditional Teaching: A Comparison Between Medical and Dentistry Students. Procedia - Social and Behavioral Sciences. 2012; 47(1): 2080- 2083.
  19. Pourghaznein T, Sabeghi H, Shariatinejad K. Effects of e-learning, lectures, and role playing on nursing students' knowledge acquisition, retention and satisfaction. Medical journal of the Islamic Republic of 2015; 29(1):162-165.
  20. Davies A, Macleod R, Bennett-Britton I, et al., E-learning and near-peer teaching in electrocardiogram education: a randomised trial. Clin 2016; 13(3): 227-230.
  21. Nathan A, Kelly J, Sridhar A, Collins J. Virtual interactive surgical skills classroom-A single-blinded, randomised control trial (VIRTUAL). Journal of Clinical Urology. 2021: 76-80.
  22. Paechter M, Maier B, Macher D. Students’ expectations of, and experiences in e-learning: Their relation to learning achievements and course satisfaction. Computers & 2010; 54(1): 222-229.
  23. Seltz L B, Preloger E, Hanson J L, Lane L. Ward Rounds With or Without an Attending Physician: How Interns Learn Most Academic Pediatrics. 2016;16(7): 638-644.
  24. Gordon J, Hazlett C, Ten Cate O, et al., Strategic planning in medical education: enhancing the learning environment for students in clinical settings. Med 2000; 34(10): 841-850.

© 2016-2024, Copyrights Fortune Journals. All Rights Reserved