Enhancing procedural knowledge in pregraduate surgical education: A controlled field study of interactive blended learning

Background: Pregraduate surgical curricula must effectively bridge the gap between fundamental knowledge and its clinical applications within the limited time available. This transition from conceptual to procedural knowledge presents a challenge for students in conventional teaching formats. This study aims to facilitate the transition from conceptual to procedural surgical knowledge using an iterative blended learning approach to promote learning efficiency. Methods: This controlled field study with voluntary opt-in incorporates in the three-week surgical curriculum of fourth-year medical students. Students engaged with asynchronous remote learning contents of conceptual knowledge via interactive videos and self-assessment. Following this, procedural knowledge was addressed in synchronous interactive case discussions, which was tested by multimodal self-assessment. Educational concepts of clinical reasoning, hybrid teaching, key feature cases, and evidence-based teaching were used. Results: 182 students generated 715 interactions in 90 minutes of interactive case discussion. In the posttest, students achieved a mean score of 71.25% for conceptual knowledge and 52.31% for procedural knowledge. In contrast to conceptual knowledge, procedural knowledge demonstrated significantly increased scores in students who participated in-person (p<0.001). No significant difference was found between online and no participation (p=0.562). While prior interest and experience in surgery showed a low correlation with posttest performance (p=0.554), the type of participation correlated strongly with posttest scores (p<0.001). Conclusions: In conclusion, active learning through case discussions leads to high student interaction. While conceptual surgical knowledge can be effectively taught through asynchronous remote learning, procedural knowledge should be taught through interactive, case-based learning, preferably in person.