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Blended learning is an approach to learning that combines face-to-face instruction with e-learning experiences. It draws on the advantages of each approach while seeking to mitigate their recognised disadvantages. The Master in Oncoplastic Breast Surgery programme at UEA is aimed at advanced surgical trainees working in approved training units in the UK and internationally. It comprises a series of complex cases discussed by the students in an on-line, asynchronous discussion forum moderated by a member of faculty. Students can participate at their convenience despite varied clinical rotas and different time zones. A case-based, flipped learning course for surgical trainees was piloted. Instructional materials for each case were provided. Students joined in an asynchronous, moderated discussion forum. 64 trainees randomised into 2 groups participated. They sat a pre-test Script Concordance Test (SCT). Group A then commenced the on-line course while Group B continued with their usual hospital-based teaching. After 8 weeks, they sat the same SCT. Group B then joined the on-line course along with Group A. After week 16, they sat another SCT. Pre-test scores for both groups were the same (A 6.45; B 6.59 p=0.78). At 8 weeks Group A’s scores had improved significantly (7.96 p<0.001) while Group B’s remained unchanged (6.54). At 16 weeks the scores had equalised (A 7.13; B 7.18). The trainees self-rating of confidence in managing 8 common surgical emergencies followed a similar pattern. Our experience suggests that on-line learning that is highly interactive can add value to the usual postgraduate clinical training. We are exploring its utility in other settings such as training nurse associates, and in breast care nursing in the UK and developing countries. We have introduced 3600 filming and virtual reality in teaching practical skills and providing induction training for complex clinical environments.
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