Comparison of the learning outcomes achieved through text-based and video-based online training of anesthesia residents in jet ventilation and anesthesia techniques for microlaryngeal surgery: a multicenter randomized trial

Comparison of the learning outcomes achieved through text-based and video-based online training of anesthesia residents in jet ventilation and anesthesia techniques for microlaryngeal surgery: a multicenter randomized trial | 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 Comparison of the learning outcomes achieved through text-based and video-based online training of anesthesia residents in jet ventilation and anesthesia techniques for microlaryngeal surgery: a multicenter randomized trial Sawita Kanavitoon, Saowapark Chumpathong, Arpa Chutipongtanate, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2618704/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Jun, 2024 Read the published version in Siriraj Medical Journal → Version 1 posted You are reading this latest preprint version Abstract Background Effective clinical training is essential for healthcare personnel with clinical skill requirements to ensure that the required standard of care is provided. This study aimed to identify an effective learning medium for anesthesia residents by comparing text-based and video-based online training. Methods This randomized, multicenter study was conducted online between October 2020 and March 2021. Three Thai institutions were involved: the Faculty of Medicine Siriraj Hospital, Mahidol University; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University; and the Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University. In all, 126 anesthesia residents responded. They were randomized into a “text group” and a “video group.” Four residents were subsequently excluded from the analyses due to contamination of their learning material from the other group. The 122 eligible students undertook 3 knowledge and skill assessments (“Pretest,” “Posttest 1,” and “Posttest 2”). The primary outcome for both study groups was the gain score after training. This was measured in 2 ways: the difference between the Posttest 1 and Pretest scores and the difference between the Posttest 2 and Pretest scores. Results The mean gain scores for Pretest and Posttest 1 were 6.78 ± 6.59 for the text group and 5.77 ± 3.74 for the video group, with no significant difference ( P = 0.347). The mean differences between the Posttest 2 and Pretest scores were 4.69 ± 9.13 for the text group and 3.47 ± 9.07 for the video group, without a significant difference ( P = 0.488). The mean satisfaction score of the video group was significantly higher. Conclusions This study demonstrated a significantly higher degree of satisfaction with video-based training but without a significant commensurate improvement in gain score. The results suggest that the online video technique can be helpful in the teaching of clinical skills. Anesthesia resident Jet ventilation Learning outcomes Microlaryngeal surgery Self-study-based Video-based Figures Figure 1 Figure 2 Figure 3 Background E-learning has played an important role in medical education, especially since the COVID-19 pandemic. In contrast to conventional bedside teaching, it enables “anytime-anywhere” access and is suitable for learners who want to learn the content of a training course at their own pace. It is used for many medical specialties, including anesthesia. The Royal College of Anaesthetists has developed a web-based resource, e-Learning Anaesthesia (e-LA), that provides knowledge and core concepts for trainees to assist in their preparation for examinations. In the case of clinical skills training, knowledge of each skill (the cognition stage) is required before dependent and independent skills practice (the integration and automation phases)( 1 ). Indications, contraindications, procedural steps, complications, and complication prevention strategies are emphasized before learners undertake skills practice. Various learning modalities can be used to promote knowledge acquisition and students’ transition to a higher degree of competence. Low-pressure low-frequency jet ventilation (LPLFJV) is a safe, tubeless airway technique. It is occasionally used for airway surgery as a rescue technique in “cannot intubate-cannot ventilate” situations ( 2 , 3 ). LPLFJV is usually applied at the supraglottic level, thereby providing proper airway support with a lower risk of airway fire and less hypercapnia than high-frequency jet ventilation (HFJV) ( 3 , 4 ). The learning of LPLFJV by novices is challenging. This is because they have limited schema related to the topic, and there are many details on special equipment and monitoring, anesthesia choice, complications, and communication between surgeons and anesthesiologists. In Thailand, clinical knowledge and skills for anesthesia for jet ventilation and microlaryngeal surgery are taught simultaneously during patient encounters. However, varieties in patient pathologies and the time constraints imposed by clinical settings limit the knowledge that residents can gain. Findings from previous studies support the notion that various types of learners achieve better training outcomes with video-based training than with conventional techniques or text-based online materials ( 5 – 9 ). Additionally, there is evidence that video-based training improves clinical skills and enhances short-term memory relative to text-based resources ( 10 – 12 ). This study compared the cognitive learning outcomes and satisfaction levels achieved with video-based and text-based online learning to identify which technique is superior and preferable for anesthesia residents. The specific research question was whether implementing online video-based training for jet ventilation and microlaryngeal surgery improves the cognitive domain learning outcomes of anesthesia residents of Siriraj Hospital, Ramathibodi Hospital, and Songklanagarind Hospital. Methods Study design, setting, and population This prospective randomized study recruited residents undertaking a 3-year anesthesia residency program. All residents enrolled in the program during the study period were eligible to participate. Their involvement was voluntary, and they had the right to withdraw at any stage. The residents signaled their informed consent to participate in the study by clicking on an “agree-to-proceed” button on the online site; this action automatically initiated a pretest. All data were de-identified, treated confidentially, and restricted to the researchers and research assistants involved in this study. Before this research began, its protocol was approved by the Institutional Review Boards of the Faculty of Medicine Siriraj Hospital (492/2020), the Faculty of Medicine, Prince of Songkla University (40281/2020), and the Faculty of Medicine, Ramathibodi Hospital (1503/2020). Sampling process A stratified randomization technique was used to form 2 groups: a “text group” and a “video group.” The randomization was based on each participant’s year in the anesthesia residency program (first, second, or third). For each program year, the same number of residents was assigned to each group. A target sample size of 102 was determined by estimating the effect size to be 0.5, which is a medium size for an educational study ( 9 ). The sample size was calculated for a 1-sided, independent-samples t-test using the following parameters: effect size = 0.5, P = 0.05, type I error = 5%, and power = 80%. The calculation was performed in G*Power (version 3.1). After allowing for a dropout of 20%, the total sample size was determined to be 124 participants. In all, 126 residents were enrolled in the study (74 from Siriraj Hospital, 29 students from Ramathibodi Hospital, and 23 from Songklanagarind Hospital). However, 4 residents were later excluded from our analyses due to contamination of their learning material from the other group. In the end, there were 122 participants (Siriraj Hospital, 72; Ramathibodi Hospital, 27; and Songklanagarind Hospital, 23). Sixty participants were allocated to the text group, while 62 were assigned to the video group. Research instruments Video and text learning materials and 40 multiple-choice questions (MCQs) were developed and validated by 3 senior anesthesiologists at Siriraj Hospital, Mahidol University. Each anesthesiologist had at least 10 years of experience with ear, nose, and throat procedures and was familiar with jet ventilation techniques. The MCQs assessed the remembering, comprehending, applying, analyzing, and synthesizing of the clinical skills and information provided in the video and text learning materials. The index of objective congruence (IOC) was used to validate the MCQs. Nineteen MCQs had an IOC = 1; the 21 other MCQs had an IOC = 0.67. The MCQs were used to form 3 sets of tests. Although each set had the same 40 MCQs, the questions were presented in a markedly different order in each set. Additionally, the test sets covered the same table of specifications used for knowledge in the video and text learning materials. No differences were found in the knowledge and learning points of the video- and text-group materials. In addition, two 5-point Likert-scale questionnaires—one for the video group and the other for the text group—were developed to evaluate participants’ satisfaction with the quality of the materials and their feelings toward the learning media. These satisfaction questionnaires were divided into 6 domains that gauged students’ perceptions of the following: the ease of understanding the content the degree of increase in confidence after learning a better technique than learning through clinical observation a better technique than learning in the operating room the likelihood of rereading or rewatching the material (as appropriate) overall satisfaction Procedure and data analysis The study was conducted from October 2020 to March 2021. The assigned learning materials, the 3 sets of MCQ tests, and the 2 versions of the satisfaction questionnaire were distributed online via the Siriraj E-Learning and Education Community (SELECx) website. The participants logged on with individually assigned usernames and passwords to access either the text- or video-based learning material (depending on whether they had been randomized to the text or video group). They also had to log on to perform the MCQ tests and complete the questionnaires. There were time limits between performing the online study and the MCQ tests. The first MCQ test (the “Pretest”) was performed before participants commenced online learning. The second MCQ test (“Posttest 1”) was taken within 7 days of the Pretest and within 24 hours of completion of the online learning material. The last MCQ test (“Posttest 2”) was taken 3 months after each participant had finished using the online material. The participants could review the learning material at any time during the study period; the date of each review by a participant was recorded (Fig. 1 ). At the same time as taking Posttest 2, each participant completed the satisfaction questionnaire on the effectiveness of the video-based or text-based training material (as appropriate). The confidentiality of the participants’ responses to the 3 sets of MCQ tests and the satisfaction questionnaires was secured by restricting the data to the research team and information technology staff. Results Demographic characteristics In all, 122 residents enrolled in years 1, 2, and 3 of the anesthesia residency program participated in the study. Of these, 72 (59.0%) were students at Siriraj Hospital, 27 (22.1%) attended Ramathibodi Hospital, and 23 (18.9%) were from Songklanagarind Hospital. There were no significant differences in the mean age, mean grade point average (GPA), sex, or training year of the participants assigned to the video and text groups. The demographic data of the residents are summarized in Table 1 . Table 1 Participant demographic data ( N = 122) Text group ( n = 60) Video group ( n = 62) P Sex Male 15 (26.3%) 12 (21.4%) 0.542 Female 42 (73.7%) 44 (78.6%) Training year First 19 (31.7%) 22 (35.5%) 0.856 Second 20 (33.3%) 21 (33.9%) Third 21 (35.0%) 19 (30.6%) Age 27.97 (1.25) 27.85 (2.63) 0.811 GPA 3.43 (0.24) 3.43 (0.28) 0.975 Center* 1 37 (61.7%) 35 (56.5%) 0.328 2 10 (16.7%) 17 (27.4%) 3 13 (21.7%) 10 (16.1%) *Center 1 = Siriraj Hospital, Mahidol University; Center 2 = Ramathibodi Hospital, Mahidol University; Center 3 = Songklanagarind Hospital, Prince of Songkla University. Data are presented as n (percentage). Analysis of the learning outcomes of the text group and the video group The mean ± SD scores achieved by the text-group participants for Pretest, Posttest 1, and Posttest 2 were 23.10 ± 7.17, 29.78 ± 4.79, and 27.24 ± 6.93, respectively (Fig. 2 ). The corresponding values for the video group were 23.08 ± 6.35, 29.72 ± 3.70, and 26.89 ± 7.43. There were no significant differences between the 2 groups’ Pretest, Posttest 1, and Posttest 2 scores, with P = 0.987, 0.941, and 0.800 from the independent-samples t-test. Analysis of the gain scores of the text group and the video group after learning Two gain scores were employed to evaluate the degrees of learning the text and video group members achieved. One gain score was the difference between the Posttest 1 and Pretest scores; the difference between the Posttest 2 and Pretest scores represented the other gain score. The gain scores for Postest 1 and the Pretest were 6.78 ± 6.59 for the text group and 5.77 ± 3.74 for the video group, with no significant difference ( P = 0.347). The gain scores for Posttest 2 and the Pretest were 4.69 ± 9.13 for the text group and 3.47 ± 9.07 for the video group, without a significant difference ( P = 0.488; Table 2 ). Table 2 Comparison of gain scores after learning with text-based and video-based materials Text group ( n = 62) Video group ( n = 60) P -value between text and video groups M (SD) P M (SD) P Posttest 1-Pretest 6.78 (6.59) 0.000 5.77 (3.74) 0.000 0.347 Posttest 2-Pretest 4.69 (9.13) 0.000 3.47 (9.07) 0.006 0.488 Posttest 2-Posttest 1 -2.18 (6.53) 0.023 -3.10 (6.82) 0.002 0.495 Data are presented as the mean (SD). Analysis of the long-term memory results of the text group and the video group The phase between Posttest 1 and Posttest 2 was employed to assess the degree of conversion from working memory to long-term memory. Our study found a general decrease in the MCQ test scores between Posttest 2 and Posttest 1 for individual students. The mean differences were − 2.18 ± 6.53 for the text group and − 3.10 ± 6.82 for the video group, with no significant difference between the groups ( P = 0.495; Table 2 ). Analysis of perceptions of the effectiveness of video-based and text-based learning An independent-samples t-test was performed to find any significant differences between the groups’ mean scores for the 6 domains of the satisfaction questionnaires (Fig. 3 ). The video-group students had significantly higher scores for ease of understanding the content ( P = 0.001), a better technique than clinical observation ( P = 0.042), a better technique than learning in the operating room ( P = 0.004), and overall satisfaction ( P = 0.02). In contrast, the text-group students demonstrated a better mean score for the likelihood of rereading the text-based material than the video-group students had for rewatching the videos. However, the difference was nonsignificant ( P = 0.285). Discussion This study drew upon validated MCQ sets to evaluate the degree of knowledge acquired after training in a clinical skill using text-based and video-based online materials. The results revealed that video-based online learning was as effective as text-based learning. This finding accords with a prior study that found no differences in students’ theoretical knowledge of the Dix–Hallpike test and blood pressure recording in theory assessments conducted via MCQs ( 13 ). However, the present investigation found different results from another study suggesting that higher-level tools that utilize video recordings with simple or complex animation can result in greater knowledge acquisition than lower-level modalities that provide text, audio, or a simple presentation ( 14 ). However, the current investigation assessed the “knows” and “knows how” via MCQ tests, while clinical performance was not examined. Meanwhile, assessments based on new technologies were recommended to improve simulation experiences and consequently better evaluate clinical performance ( 15 ). Additionally, other studies showed that while there were no differences in test scores for the theory parts of information presented via video- and text-based e-learning materials, scoring differences were found for procedurally related information ( 9 , 16 ). Regarding perceptions, the students were satisfied with both e-learning methods, rating each as better than traditional learning through clinical observation or in the operating room. The students rated video-based e-learning more highly than text-based e-learning in terms of overall satisfaction, ease of understanding the content, and a better technique than clinical observation or operating-room learning. This finding can be explained by dual-coding theory, which holds that combining visual and auditory stimuli to present information promotes student learning and improves memory. The students also rated video-based e-learning more highly in terms of their perceived increases in confidence after learning. In terms of memory decay, time weakened the retention of memories in the text and video groups. Analysis of the gain scores for Posttest 2 (taken 3 months after each participant had finished using the online material) and the Pretest revealed the same memory decay rate for both groups. This finding is consistent with memory decay theory, which explains how time affects the retention of memories ( 17 ). Even the current investigation’s video-based e-learning, which promotes dual encoding, could not enable our students to memorize content completely. No previous study has compared the decay rates of text- and video-based e-learning. To promote long-term memory, content rehearsal for any form of e-learning should be emphasized in future research on other learner types (ie, visual, auditory, and kinesthetic) to gain more information on the effectiveness of different e-learning modalities. Limitations And Future Research This study has several limitations. First, there were no data on each participant’s preferred learning style, which might affect the learning outcomes achievable with different training techniques. Second, the MCQ tests only evaluated one aspect of cognition. The test results may not adequately reflect the practical skill and process elements of anesthesia training. Research using multi-aspect measurements for skill-based evaluations (eg, Objective Structured Clinical Examination) would provide more comprehensive data for assessing student learning. Third, this study evaluated the learning techniques by comparing the learning outcomes achieved with text-based and video-based e-learning resources for just 1 clinical skill. Therefore, it may not be possible to generalize our results to learning other skills. Further research on other skill types would provide more information on the effectiveness of different e-learning methods. Conclusions Although video-based online training was not superior to text-based e-learning material, students preferred the technique. Video-based online training can facilitate learning prior to clinical encounters. Declarations Ethics approval and consent to participate Ethics approval was obtained from the Faculty of Medicine Siriraj Hospital, Mahidol University; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University; and the Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University. Permission from the administrations of Mahidol University and Prince of Songkla University was also obtained. Participation in the study was entirely voluntary. Prospective enrollees were provided with information sheets explaining the study’s objectives. Written informed consent was obtained from the participants before they completed the study questionnaire. All methods were performed per relevant guidelines and regulations. Consent for publication Not applicable. Availability of data and materials Data and materials can be obtained from the corresponding author upon request. Competing interests The authors have no competing interests to declare. Funding The Faculty of Medicine Siriraj Hospital, Mahidol University, funded the study. The funding supported the study process of this research. Author’s contributions Sawita Kanavitoon: This author helped with the conception of the study; the collection, analysis, and interpretation of data; and the drafting, critical revision, and approval of the manuscript. Saowapark Chumpathong: This author helped with the conception of the study; the analysis and interpretation of data; and the drafting, critical revision, and approval of the manuscript. Sirirat Rattanaarpa: This author helped with the conception of the study and the drafting, critical revision, and approval of the manuscript. Arpa Chutipongtanate: This author helped with the conception of the study and the drafting, critical revision, and approval of the manuscript. Jutarat Tanasansuttiporn: This author helped with the conception of the study and the drafting, critical revision, and approval of the manuscript. Acknowledgments We thank all anesthesia residents from Years 1 to 3 at Siriraj Hospital, Ramathibodi Hospital, and Songklanagarind Hospital for their valuable time participating in this study. We also thank Miss Pavinee Sareenun for her efforts in developing the online learning material with the assistance of the information technology staff. References Fitts P, Posner M. Human Performance. Reprint of ed. Brooks/Cole Pub Co. Westport, CT, Greenwood Press; 1979. Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022;136(1):31-81. 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Lee NJ, Chae SM, Kim H, Lee JH, Min HJ, Park DE. Mobile-Based Video Learning Outcomes in Clinical Nursing Skill Education: A Randomized Controlled Trial. Comput Inform Nurs. 2016;34(1):8-16. Choi Y, Song E, Oh E. Effects of teaching communication skills using a video clip on a smart phone on communication competence and emotional intelligence in nursing students. Arch Psychiatr Nurs. 2015;29(2):90-5. Soucisse ML, Boulva K, Sideris L, Drolet P, Morin M, Dube P. Video Coaching as an Efficient Teaching Method for Surgical Residents-A Randomized Controlled Trial. J Surg Educ. 2017;74(2):365-71. Mishra K, Mathai M, Della Rocca RC, Reddy HS. Improving Resident Performance in Oculoplastic Surgery: A New Curriculum Using Surgical Wet Laboratory Videos. J Surg Educ. 2017;74(5):837-42. Ludwig S, Schuelper N, Brown J, Anders S, Raupach T. How can we teach medical students to choose wisely? A randomised controlled cross-over study of video- versus text-based case scenarios. BMC Med. 2018;16(1):107. Buch SV, Treschow FP, Svendsen JB, Worm BS. Video- or text-based e-learning when teaching clinical procedures? A randomized controlled trial. Adv Med Educ Pract. 2014;5:257-62. Worm BS, Jensen K. Does peer learning or higher levels of e-learning improve learning abilities? A randomized controlled trial. Med Educ Online. 2013;18:21877. Thakker A, Devani P. Is there a role for virtual reality in objective structured clinical examinations (OSCEs)? MedEdPublish. 2019;8(180):180. Padmavathi R, Omprakash A, Kumar AP. Video demonstration as a teaching-learning method for a core clinical skill among undergraduate medical students: An interventional study. National Journal of Physiology, Pharmacy and Pharmacology. 2019;9(6):547-. Ricker TJ, Vergauwe E, Cowan N. Decay theory of immediate memory: From Brown (1958) to today (2014). Q J Exp Psychol (Hove). 2016;69(10):1969-95. Additional Declarations No competing interests reported. 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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-2618704","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":182044076,"identity":"784127dd-a1c3-4632-b41b-becc8eef73b4","order_by":0,"name":"Sawita Kanavitoon","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYHACxgMMDDYJYGZCAZF6gFrSEhjYQFoMiNdyGKKFgRgt8u3dCQc+/Dmfxy/fnfjhgQGDPL/YAfxaDM6c3XBwZtvtYsk23s0SQIcZzpydQECLRO6Gw7wNtxM3HOPdANKSYHCbgBb5GUAtf/6cA2nZ/IMoLQw3gFoY2A6AtGwjzhawX3rbkhNntuVus0gwkCDsF/n23o0PfvyxS+xnPrv55o8KG3l+aUIOQwMSpCkfBaNgFIyCUYAdAAB8iEp+sTC42AAAAABJRU5ErkJggg==","orcid":"","institution":"Mahidol University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Sawita","middleName":"","lastName":"Kanavitoon","suffix":""},{"id":182044078,"identity":"b269b1ea-bd24-4e0e-9a90-76255230817b","order_by":1,"name":"Saowapark Chumpathong","email":"","orcid":"","institution":"Mahidol University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Saowapark","middleName":"","lastName":"Chumpathong","suffix":""},{"id":182044080,"identity":"1a6e8a4f-39c5-4b01-9763-a5c95782425f","order_by":2,"name":"Arpa Chutipongtanate","email":"","orcid":"","institution":"Cincinnati Children's Hospital Medical Center, Mahidol University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Arpa","middleName":"","lastName":"Chutipongtanate","suffix":""},{"id":182044082,"identity":"baf5249f-b7eb-4a32-aea3-018dfc4f3c80","order_by":3,"name":"Jutarat Tanasansuttiporn","email":"","orcid":"","institution":"Prince of Songkla University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jutarat","middleName":"","lastName":"Tanasansuttiporn","suffix":""},{"id":182044083,"identity":"ffcb2fc7-2065-41bb-ae85-a9928d1206de","order_by":4,"name":"Sirirat Rattanaarpa","email":"","orcid":"","institution":"Mahidol University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sirirat","middleName":"","lastName":"Rattanaarpa","suffix":""}],"badges":[],"createdAt":"2023-02-23 04:29:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2618704/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2618704/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.33192/smj.v76i7.267386","type":"published","date":"2024-07-01T00:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":34236111,"identity":"c2858b5e-5d65-4a43-ae5e-55b1531539b1","added_by":"auto","created_at":"2023-03-14 14:43:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":119272,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart for study implementation\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-2618704/v1/1489a63e30c294357e24ac4b.png"},{"id":34236112,"identity":"c605e2e5-7087-4693-b2c3-7d59bb2d42a6","added_by":"auto","created_at":"2023-03-14 14:43:01","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":158853,"visible":true,"origin":"","legend":"\u003cp\u003eMCQ test scores for Pretest, Posttest 1, and Posttest 2 of the video group and the text group\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2618704/v1/ace380104911b76b21c0a2cc.jpg"},{"id":34236113,"identity":"ddd292c8-7a50-4bb4-ad2b-bfb7e5b75978","added_by":"auto","created_at":"2023-03-14 14:43:01","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":240571,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of the participant perceptions of the effectiveness of video-based and text-based learning\u003c/p\u003e\n\u003cp\u003e* \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2618704/v1/10cc59a31a23d0ec06bf1033.jpg"},{"id":59947761,"identity":"ac55a353-a5b3-4757-b22b-9af74058af42","added_by":"auto","created_at":"2024-07-09 16:28:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1086948,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2618704/v1/b3ea1ef8-818a-483a-b17a-fb47b1025395.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of the learning outcomes achieved through text-based and video-based online training of anesthesia residents in jet ventilation and anesthesia techniques for microlaryngeal surgery: a multicenter randomized trial","fulltext":[{"header":"Background","content":"\u003cp\u003eE-learning has played an important role in medical education, especially since the COVID-19 pandemic. In contrast to conventional bedside teaching, it enables \u0026ldquo;anytime-anywhere\u0026rdquo; access and is suitable for learners who want to learn the content of a training course at their own pace. It is used for many medical specialties, including anesthesia. The Royal College of Anaesthetists has developed a web-based resource, e-Learning Anaesthesia (e-LA), that provides knowledge and core concepts for trainees to assist in their preparation for examinations. In the case of clinical skills training, knowledge of each skill (the cognition stage) is required before dependent and independent skills practice (the integration and automation phases)(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Indications, contraindications, procedural steps, complications, and complication prevention strategies are emphasized before learners undertake skills practice. Various learning modalities can be used to promote knowledge acquisition and students\u0026rsquo; transition to a higher degree of competence.\u003c/p\u003e \u003cp\u003eLow-pressure low-frequency jet ventilation (LPLFJV) is a safe, tubeless airway technique. It is occasionally used for airway surgery as a rescue technique in \u0026ldquo;cannot intubate-cannot ventilate\u0026rdquo; situations (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). LPLFJV is usually applied at the supraglottic level, thereby providing proper airway support with a lower risk of airway fire and less hypercapnia than high-frequency jet ventilation (HFJV) (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The learning of LPLFJV by novices is challenging. This is because they have limited schema related to the topic, and there are many details on special equipment and monitoring, anesthesia choice, complications, and communication between surgeons and anesthesiologists. In Thailand, clinical knowledge and skills for anesthesia for jet ventilation and microlaryngeal surgery are taught simultaneously during patient encounters. However, varieties in patient pathologies and the time constraints imposed by clinical settings limit the knowledge that residents can gain.\u003c/p\u003e \u003cp\u003eFindings from previous studies support the notion that various types of learners achieve better training outcomes with video-based training than with conventional techniques or text-based online materials (\u003cspan additionalcitationids=\"CR6 CR7 CR8\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Additionally, there is evidence that video-based training improves clinical skills and enhances short-term memory relative to text-based resources (\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study compared the cognitive learning outcomes and satisfaction levels achieved with video-based and text-based online learning to identify which technique is superior and preferable for anesthesia residents. The specific research question was whether implementing online video-based training for jet ventilation and microlaryngeal surgery improves the cognitive domain learning outcomes of anesthesia residents of Siriraj Hospital, Ramathibodi Hospital, and Songklanagarind Hospital.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy design, setting, and population\u003c/h2\u003e\n\u003cp\u003eThis prospective randomized study recruited residents undertaking a 3-year anesthesia residency program. All residents enrolled in the program during the study period were eligible to participate. Their involvement was voluntary, and they had the right to withdraw at any stage. The residents signaled their informed consent to participate in the study by clicking on an \u0026ldquo;agree-to-proceed\u0026rdquo; button on the online site; this action automatically initiated a pretest. All data were de-identified, treated confidentially, and restricted to the researchers and research assistants involved in this study. Before this research began, its protocol was approved by the Institutional Review Boards of the Faculty of Medicine Siriraj Hospital (492/2020), the Faculty of Medicine, Prince of Songkla University (40281/2020), and the Faculty of Medicine, Ramathibodi Hospital (1503/2020).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003eSampling process\u003c/h2\u003e\n\u003cp\u003eA stratified randomization technique was used to form 2 groups: a \u0026ldquo;text group\u0026rdquo; and a \u0026ldquo;video group.\u0026rdquo; The randomization was based on each participant\u0026rsquo;s year in the anesthesia residency program (first, second, or third). For each program year, the same number of residents was assigned to each group. A target sample size of 102 was determined by estimating the effect size to be 0.5, which is a medium size for an educational study (\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e). The sample size was calculated for a 1-sided, independent-samples t-test using the following parameters: effect size\u0026thinsp;=\u0026thinsp;0.5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05, type I error\u0026thinsp;=\u0026thinsp;5%, and power\u0026thinsp;=\u0026thinsp;80%. The calculation was performed in G*Power (version 3.1). After allowing for a dropout of 20%, the total sample size was determined to be 124 participants. In all, 126 residents were enrolled in the study (74 from Siriraj Hospital, 29 students from Ramathibodi Hospital, and 23 from Songklanagarind Hospital). However, 4 residents were later excluded from our analyses due to contamination of their learning material from the other group. In the end, there were 122 participants (Siriraj Hospital, 72; Ramathibodi Hospital, 27; and Songklanagarind Hospital, 23). Sixty participants were allocated to the text group, while 62 were assigned to the video group.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003eResearch instruments\u003c/h2\u003e\n\u003cp\u003eVideo and text learning materials and 40 multiple-choice questions (MCQs) were developed and validated by 3 senior anesthesiologists at Siriraj Hospital, Mahidol University. Each anesthesiologist had at least 10 years of experience with ear, nose, and throat procedures and was familiar with jet ventilation techniques. The MCQs assessed the remembering, comprehending, applying, analyzing, and synthesizing of the clinical skills and information provided in the video and text learning materials. The index of objective congruence (IOC) was used to validate the MCQs. Nineteen MCQs had an IOC\u0026thinsp;=\u0026thinsp;1; the 21 other MCQs had an IOC\u0026thinsp;=\u0026thinsp;0.67. The MCQs were used to form 3 sets of tests. Although each set had the same 40 MCQs, the questions were presented in a markedly different order in each set. Additionally, the test sets covered the same table of specifications used for knowledge in the video and text learning materials. No differences were found in the knowledge and learning points of the video- and text-group materials.\u003c/p\u003e\n\u003cp\u003eIn addition, two 5-point Likert-scale questionnaires\u0026mdash;one for the video group and the other for the text group\u0026mdash;were developed to evaluate participants\u0026rsquo; satisfaction with the quality of the materials and their feelings toward the learning media. These satisfaction questionnaires were divided into 6 domains that gauged students\u0026rsquo; perceptions of the following:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003ethe ease of understanding the content\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ethe degree of increase in confidence after learning\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ea better technique than learning through clinical observation\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ea better technique than learning in the operating room\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ethe likelihood of rereading or rewatching the material (as appropriate)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eoverall satisfaction\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003eProcedure and data analysis\u003c/h2\u003e\n\u003cp\u003eThe study was conducted from October 2020 to March 2021. The assigned learning materials, the 3 sets of MCQ tests, and the 2 versions of the satisfaction questionnaire were distributed online via the Siriraj E-Learning and Education Community (SELECx) website. The participants logged on with individually assigned usernames and passwords to access either the text- or video-based learning material (depending on whether they had been randomized to the text or video group). They also had to log on to perform the MCQ tests and complete the questionnaires. There were time limits between performing the online study and the MCQ tests. The first MCQ test (the \u0026ldquo;Pretest\u0026rdquo;) was performed before participants commenced online learning. The second MCQ test (\u0026ldquo;Posttest 1\u0026rdquo;) was taken within 7 days of the Pretest and within 24 hours of completion of the online learning material. The last MCQ test (\u0026ldquo;Posttest 2\u0026rdquo;) was taken 3 months after each participant had finished using the online material. The participants could review the learning material at any time during the study period; the date of each review by a participant was recorded (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eAt the same time as taking Posttest 2, each participant completed the satisfaction questionnaire on the effectiveness of the video-based or text-based training material (as appropriate). The confidentiality of the participants\u0026rsquo; responses to the 3 sets of MCQ tests and the satisfaction questionnaires was secured by restricting the data to the research team and information technology staff.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eDemographic characteristics\u003c/h2\u003e\n\u003cp\u003eIn all, 122 residents enrolled in years 1, 2, and 3 of the anesthesia residency program participated in the study. Of these, 72 (59.0%) were students at Siriraj Hospital, 27 (22.1%) attended Ramathibodi Hospital, and 23 (18.9%) were from Songklanagarind Hospital. There were no significant differences in the mean age, mean grade point average (GPA), sex, or training year of the participants assigned to the video and text groups. The demographic data of the residents are summarized in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eParticipant demographic data (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;122)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eText group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVideo group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSex\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15 (26.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12 (21.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.542\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e42 (73.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e44 (78.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTraining year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFirst\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19 (31.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e22 (35.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.856\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSecond\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20 (33.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21 (33.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eThird\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21 (35.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19 (30.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e27.97 (1.25)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e27.85 (2.63)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.811\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGPA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.43 (0.24)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.43 (0.28)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.975\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCenter*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e37 (61.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35 (56.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.328\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10 (16.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e17 (27.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13 (21.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10 (16.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003e*Center 1\u0026thinsp;=\u0026thinsp;Siriraj Hospital, Mahidol University; Center 2\u0026thinsp;=\u0026thinsp;Ramathibodi Hospital, Mahidol University; Center 3\u0026thinsp;=\u0026thinsp;Songklanagarind Hospital, Prince of Songkla University.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003eData are presented as n (percentage).\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003ch2\u003eAnalysis of the learning outcomes of the text group and the video group\u003c/h2\u003e\n\u003cp\u003eThe mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD scores achieved by the text-group participants for Pretest, Posttest 1, and Posttest 2 were 23.10\u0026thinsp;\u0026plusmn;\u0026thinsp;7.17, 29.78\u0026thinsp;\u0026plusmn;\u0026thinsp;4.79, and 27.24\u0026thinsp;\u0026plusmn;\u0026thinsp;6.93, respectively (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The corresponding values for the video group were 23.08\u0026thinsp;\u0026plusmn;\u0026thinsp;6.35, 29.72\u0026thinsp;\u0026plusmn;\u0026thinsp;3.70, and 26.89\u0026thinsp;\u0026plusmn;\u0026thinsp;7.43. There were no significant differences between the 2 groups\u0026rsquo; Pretest, Posttest 1, and Posttest 2 scores, with \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.987, 0.941, and 0.800 from the independent-samples t-test.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003eAnalysis of the gain scores of the text group and the video group after learning\u003c/h2\u003e\n\u003cp\u003eTwo gain scores were employed to evaluate the degrees of learning the text and video group members achieved. One gain score was the difference between the Posttest 1 and Pretest scores; the difference between the Posttest 2 and Pretest scores represented the other gain score. The gain scores for Postest 1 and the Pretest were 6.78\u0026thinsp;\u0026plusmn;\u0026thinsp;6.59 for the text group and 5.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.74 for the video group, with no significant difference (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.347). The gain scores for Posttest 2 and the Pretest were 4.69\u0026thinsp;\u0026plusmn;\u0026thinsp;9.13 for the text group and 3.47\u0026thinsp;\u0026plusmn;\u0026thinsp;9.07 for the video group, without a significant difference (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.488; Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eComparison of gain scores after learning with text-based and video-based materials\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eText group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVideo group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value between text and video groups\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eM (SD)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eM (SD)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePosttest 1-Pretest\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6.78 (6.59)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.77 (3.74)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.347\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePosttest 2-Pretest\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.69 (9.13)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.47 (9.07)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.006\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.488\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePosttest 2-Posttest 1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-2.18 (6.53)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-3.10 (6.82)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.495\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eData are presented as the mean (SD).\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003eAnalysis of the long-term memory results of the text group and the video group\u003c/h2\u003e\n\u003cp\u003eThe phase between Posttest 1 and Posttest 2 was employed to assess the degree of conversion from working memory to long-term memory. Our study found a general decrease in the MCQ test scores between Posttest 2 and Posttest 1 for individual students. The mean differences were \u0026minus;\u0026thinsp;2.18\u0026thinsp;\u0026plusmn;\u0026thinsp;6.53 for the text group and \u0026minus;\u0026thinsp;3.10\u0026thinsp;\u0026plusmn;\u0026thinsp;6.82 for the video group, with no significant difference between the groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.495; Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003eAnalysis of perceptions of the effectiveness of video-based and text-based learning\u003c/h2\u003e\n\u003cp\u003eAn independent-samples t-test was performed to find any significant differences between the groups\u0026rsquo; mean scores for the 6 domains of the satisfaction questionnaires (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). The video-group students had significantly higher scores for ease of understanding the content (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), a better technique than clinical observation (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.042), a better technique than learning in the operating room (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), and overall satisfaction (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02). In contrast, the text-group students demonstrated a better mean score for the likelihood of rereading the text-based material than the video-group students had for rewatching the videos. However, the difference was nonsignificant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.285).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study drew upon validated MCQ sets to evaluate the degree of knowledge acquired after training in a clinical skill using text-based and video-based online materials. The results revealed that video-based online learning was as effective as text-based learning. This finding accords with a prior study that found no differences in students\u0026rsquo; theoretical knowledge of the Dix\u0026ndash;Hallpike test and blood pressure recording in theory assessments conducted via MCQs (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). However, the present investigation found different results from another study suggesting that higher-level tools that utilize video recordings with simple or complex animation can result in greater knowledge acquisition than lower-level modalities that provide text, audio, or a simple presentation (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). However, the current investigation assessed the \u0026ldquo;knows\u0026rdquo; and \u0026ldquo;knows how\u0026rdquo; via MCQ tests, while clinical performance was not examined. Meanwhile, assessments based on new technologies were recommended to improve simulation experiences and consequently better evaluate clinical performance (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Additionally, other studies showed that while there were no differences in test scores for the theory parts of information presented via video- and text-based e-learning materials, scoring differences were found for procedurally related information (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRegarding perceptions, the students were satisfied with both e-learning methods, rating each as better than traditional learning through clinical observation or in the operating room. The students rated video-based e-learning more highly than text-based e-learning in terms of overall satisfaction, ease of understanding the content, and a better technique than clinical observation or operating-room learning. This finding can be explained by dual-coding theory, which holds that combining visual and auditory stimuli to present information promotes student learning and improves memory. The students also rated video-based e-learning more highly in terms of their perceived increases in confidence after learning.\u003c/p\u003e \u003cp\u003eIn terms of memory decay, time weakened the retention of memories in the text and video groups. Analysis of the gain scores for Posttest 2 (taken 3 months after each participant had finished using the online material) and the Pretest revealed the same memory decay rate for both groups. This finding is consistent with memory decay theory, which explains how time affects the retention of memories (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Even the current investigation\u0026rsquo;s video-based e-learning, which promotes dual encoding, could not enable our students to memorize content completely. No previous study has compared the decay rates of text- and video-based e-learning. To promote long-term memory, content rehearsal for any form of e-learning should be emphasized in future research on other learner types (ie, visual, auditory, and kinesthetic) to gain more information on the effectiveness of different e-learning modalities.\u003c/p\u003e\n\u003ch3\u003eLimitations And Future Research\u003c/h3\u003e\n\u003cp\u003eThis study has several limitations. First, there were no data on each participant\u0026rsquo;s preferred learning style, which might affect the learning outcomes achievable with different training techniques. Second, the MCQ tests only evaluated one aspect of cognition. The test results may not adequately reflect the practical skill and process elements of anesthesia training. Research using multi-aspect measurements for skill-based evaluations (eg, Objective Structured Clinical Examination) would provide more comprehensive data for assessing student learning. Third, this study evaluated the learning techniques by comparing the learning outcomes achieved with text-based and video-based e-learning resources for just 1 clinical skill. Therefore, it may not be possible to generalize our results to learning other skills. Further research on other skill types would provide more information on the effectiveness of different e-learning methods.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAlthough video-based online training was not superior to text-based e-learning material, students preferred the technique. Video-based online training can facilitate learning prior to clinical encounters.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eEthics approval was obtained from the Faculty of Medicine Siriraj Hospital, Mahidol University; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University; and the Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University. Permission from the administrations of Mahidol University and Prince of Songkla University was also obtained. Participation in the study was entirely voluntary. Prospective enrollees were provided with information sheets explaining the study\u0026rsquo;s objectives. Written informed consent was obtained from the participants before they completed the study questionnaire. All methods were performed per relevant guidelines and regulations.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eData and materials can be obtained from the corresponding author upon request.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors have no competing interests to declare.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe Faculty of Medicine Siriraj Hospital, Mahidol University, funded the study. The funding supported the study process of this research.\u003c/p\u003e\n\u003ch2\u003eAuthor\u0026rsquo;s contributions\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eSawita Kanavitoon:\u003c/strong\u003e This author helped with the conception of the study; the collection, analysis, and interpretation of data; and the drafting, critical revision, and approval of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSaowapark Chumpathong:\u003c/strong\u003e This author helped with the conception of the study; the analysis and interpretation of data; and the drafting, critical revision, and approval of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSirirat Rattanaarpa:\u003c/strong\u003e This author helped with the conception of the study and the drafting, critical revision, and approval of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eArpa Chutipongtanate:\u003c/strong\u003e This author helped with the conception of the study and the drafting, critical revision, and approval of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJutarat Tanasansuttiporn:\u003c/strong\u003e This author helped with the conception of the study and the drafting, critical revision, and approval of the manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgments\u003c/h2\u003e\n\u003cp\u003eWe thank all anesthesia residents from Years 1 to 3 at Siriraj Hospital, Ramathibodi Hospital, and Songklanagarind Hospital for their valuable time participating in this study.\u003c/p\u003e\n\u003cp\u003eWe also thank Miss Pavinee Sareenun for her efforts in developing the online learning material with the assistance of the information technology staff.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFitts P, Posner M. Human Performance. Reprint of ed. Brooks/Cole Pub Co. Westport, CT, Greenwood Press; 1979.\u003c/li\u003e\n\u003cli\u003eApfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022;136(1):31-81.\u003c/li\u003e\n\u003cli\u003eMyint CW, Teng SE, Butler JJ, Griffeth JV, Fritz MA, Meiler SE, et al. Low Pressure Low Frequency Jet Ventilation: Techniques, Safety and Complications. Ann Otol Rhinol Laryngol. 2022:34894211072630.\u003c/li\u003e\n\u003cli\u003eVourc\u0026apos;h G, Fischler M, Michon F, Melchior JC, Seigneur F. Manual jet ventilation v. high frequency jet ventilation during laser resection of tracheo-bronchial stenosis. Br J Anaesth. 1983;55(10):973-5.\u003c/li\u003e\n\u003cli\u003eLevitan RM, Goldman TS, Bryan DA, Shofer F, Herlich A. Training with video imaging improves the initial intubation success rates of paramedic trainees in an operating room setting. Ann Emerg Med. 2001;37(1):46-50.\u003c/li\u003e\n\u003cli\u003eJang HW, Kim KJ. Use of online clinical videos for clinical skills training for medical students: benefits and challenges. BMC Med Educ. 2014;14:56.\u003c/li\u003e\n\u003cli\u003eZhang D, Zhou L, Briggs RO, Nunamaker JF. Instructional video in e-learning: Assessing the impact of interactive video on learning effectiveness. Information \u0026amp; Management. 2006;43(1):15-27.\u003c/li\u003e\n\u003cli\u003eLee NJ, Chae SM, Kim H, Lee JH, Min HJ, Park DE. Mobile-Based Video Learning Outcomes in Clinical Nursing Skill Education: A Randomized Controlled Trial. Comput Inform Nurs. 2016;34(1):8-16.\u003c/li\u003e\n\u003cli\u003eChoi Y, Song E, Oh E. Effects of teaching communication skills using a video clip on a smart phone on communication competence and emotional intelligence in nursing students. Arch Psychiatr Nurs. 2015;29(2):90-5.\u003c/li\u003e\n\u003cli\u003eSoucisse ML, Boulva K, Sideris L, Drolet P, Morin M, Dube P. Video Coaching as an Efficient Teaching Method for Surgical Residents-A Randomized Controlled Trial. J Surg Educ. 2017;74(2):365-71.\u003c/li\u003e\n\u003cli\u003eMishra K, Mathai M, Della Rocca RC, Reddy HS. Improving Resident Performance in Oculoplastic Surgery: A New Curriculum Using Surgical Wet Laboratory Videos. J Surg Educ. 2017;74(5):837-42.\u003c/li\u003e\n\u003cli\u003eLudwig S, Schuelper N, Brown J, Anders S, Raupach T. How can we teach medical students to choose wisely? A randomised controlled cross-over study of video- versus text-based case scenarios. BMC Med. 2018;16(1):107.\u003c/li\u003e\n\u003cli\u003eBuch SV, Treschow FP, Svendsen JB, Worm BS. Video- or text-based e-learning when teaching clinical procedures? A randomized controlled trial. Adv Med Educ Pract. 2014;5:257-62.\u003c/li\u003e\n\u003cli\u003eWorm BS, Jensen K. Does peer learning or higher levels of e-learning improve learning abilities? A randomized controlled trial. Med Educ Online. 2013;18:21877.\u003c/li\u003e\n\u003cli\u003eThakker A, Devani P. Is there a role for virtual reality in objective structured clinical examinations (OSCEs)? MedEdPublish. 2019;8(180):180.\u003c/li\u003e\n\u003cli\u003ePadmavathi R, Omprakash A, Kumar AP. Video demonstration as a teaching-learning method for a core clinical skill among undergraduate medical students: An interventional study. National Journal of Physiology, Pharmacy and Pharmacology. 2019;9(6):547-.\u003c/li\u003e\n\u003cli\u003eRicker TJ, Vergauwe E, Cowan N. Decay theory of immediate memory: From Brown (1958) to today (2014). Q J Exp Psychol (Hove). 2016;69(10):1969-95.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"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":"Anesthesia resident, Jet ventilation, Learning outcomes, Microlaryngeal surgery, Self-study-based, Video-based","lastPublishedDoi":"10.21203/rs.3.rs-2618704/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2618704/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEffective clinical training is essential for healthcare personnel with clinical skill requirements to ensure that the required standard of care is provided. This study aimed to identify an effective learning medium for anesthesia residents by comparing text-based and video-based online training.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis randomized, multicenter study was conducted online between October 2020 and March 2021. Three Thai institutions were involved: the Faculty of Medicine Siriraj Hospital, Mahidol University; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University; and the Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University. In all, 126 anesthesia residents responded. They were randomized into a \u0026ldquo;text group\u0026rdquo; and a \u0026ldquo;video group.\u0026rdquo; Four residents were subsequently excluded from the analyses due to contamination of their learning material from the other group. The 122 eligible students undertook 3 knowledge and skill assessments (\u0026ldquo;Pretest,\u0026rdquo; \u0026ldquo;Posttest 1,\u0026rdquo; and \u0026ldquo;Posttest 2\u0026rdquo;). The primary outcome for both study groups was the gain score after training. This was measured in 2 ways: the difference between the Posttest 1 and Pretest scores and the difference between the Posttest 2 and Pretest scores.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean gain scores for Pretest and Posttest 1 were 6.78\u0026thinsp;\u0026plusmn;\u0026thinsp;6.59 for the text group and 5.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.74 for the video group, with no significant difference (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.347). The mean differences between the Posttest 2 and Pretest scores were 4.69\u0026thinsp;\u0026plusmn;\u0026thinsp;9.13 for the text group and 3.47\u0026thinsp;\u0026plusmn;\u0026thinsp;9.07 for the video group, without a significant difference (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.488). The mean satisfaction score of the video group was significantly higher.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study demonstrated a significantly higher degree of satisfaction with video-based training but without a significant commensurate improvement in gain score. The results suggest that the online video technique can be helpful in the teaching of clinical skills.\u003c/p\u003e","manuscriptTitle":"Comparison of the learning outcomes achieved through text-based and video-based online training of anesthesia residents in jet ventilation and anesthesia techniques for microlaryngeal surgery: a multicenter randomized trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-03-14 14:42:55","doi":"10.21203/rs.3.rs-2618704/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":"9bf7bd9e-45db-4f09-8ce6-2258a76fdb11","owner":[],"postedDate":"March 14th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-07-09T16:28:44+00:00","versionOfRecord":{"articleIdentity":"rs-2618704","link":"https://doi.org/10.33192/smj.v76i7.267386","journal":{"identity":"siriraj-medical-journal","isVorOnly":true,"title":"Siriraj Medical Journal"},"publishedOn":"2024-07-01 00:00:00","publishedOnDateReadable":"July 1st, 2024"},"versionCreatedAt":"2023-03-14 14:42:55","video":"","vorDoi":"10.33192/smj.v76i7.267386","vorDoiUrl":"https://doi.org/10.33192/smj.v76i7.267386","workflowStages":[]},"version":"v1","identity":"rs-2618704","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2618704","identity":"rs-2618704","version":["v1"]},"buildId":"-HB7Z8yhvgn0wM9Nzuekk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}