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

Enhancing procedural knowledge in pregraduate surgical education: A controlled field study of interactive blended learning | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Enhancing procedural knowledge in pregraduate surgical education: A controlled field study of interactive blended learning Paul Supper, Martin R. Fischer, Franz Kainberger, Christine Radtke This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7284460/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. Clinical reasoning hybrid teaching case-based learning key feature cases procedural knowledge Full Text Additional Declarations No competing interests reported. Supplementary Files Supplements.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7284460","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":508148930,"identity":"717dc2a4-f523-4f2a-b8cc-b2f2e3db3d3c","order_by":0,"name":"Paul Supper","email":"data:image/png;base64,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","orcid":"","institution":"Medical University of Vienna","correspondingAuthor":true,"prefix":"","firstName":"Paul","middleName":"","lastName":"Supper","suffix":""},{"id":508148931,"identity":"4d40e7c2-cdb5-43ca-a907-dab0650939aa","order_by":1,"name":"Martin R. Fischer","email":"","orcid":"","institution":"Medical University of Vienna","correspondingAuthor":false,"prefix":"","firstName":"Martin","middleName":"R.","lastName":"Fischer","suffix":""},{"id":508148933,"identity":"c48634cc-2bb5-4af1-8981-dd040a264570","order_by":2,"name":"Franz Kainberger","email":"","orcid":"","institution":"Medical University of Vienna","correspondingAuthor":false,"prefix":"","firstName":"Franz","middleName":"","lastName":"Kainberger","suffix":""},{"id":508148934,"identity":"5b1aa9c7-37f3-43a8-9a26-4c4244d51451","order_by":3,"name":"Christine Radtke","email":"","orcid":"","institution":"Medical University of Vienna","correspondingAuthor":false,"prefix":"","firstName":"Christine","middleName":"","lastName":"Radtke","suffix":""}],"badges":[],"createdAt":"2025-08-03 16:08:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7284460/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7284460/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94474321,"identity":"0a721f75-7929-44c3-83b1-c69544ac0659","added_by":"auto","created_at":"2025-10-27 15:48:22","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1161897,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscriptwithidentifiers.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7284460/v1_covered_c6c25d32-5b41-47be-99dd-0a5e16648d36.pdf"},{"id":90599634,"identity":"332ad42a-8bfc-43c8-9d37-70fcdc9b1108","added_by":"auto","created_at":"2025-09-04 14:19:58","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":496335,"visible":true,"origin":"","legend":"","description":"","filename":"Supplements.docx","url":"https://assets-eu.researchsquare.com/files/rs-7284460/v1/5253573996b45d9505395b57.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Enhancing procedural knowledge in pregraduate surgical education: A controlled field study of interactive blended learning","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Clinical reasoning, hybrid teaching, case-based learning, key feature cases, procedural knowledge","lastPublishedDoi":"10.21203/rs.3.rs-7284460/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7284460/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePregraduate 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.\u003c/p\u003e\n\u003cp\u003eThis study aims to facilitate the transition from conceptual to procedural surgical knowledge using an iterative blended learning approach to promote learning efficiency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e182 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\u0026lt;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\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn 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.\u003c/p\u003e","manuscriptTitle":"Enhancing procedural knowledge in pregraduate surgical education: A controlled field study of interactive blended learning","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-04 14:03:53","doi":"10.21203/rs.3.rs-7284460/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"eca7896f-e11a-459f-8e72-dd317ef00ae1","owner":[],"postedDate":"September 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-27T14:34:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-04 14:03:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7284460","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7284460","identity":"rs-7284460","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}