Outcomes of a Multimedia Educational Workshop in an Internal Medicine Residency

Outcomes of a Multimedia Educational Workshop in an Internal Medicine Residency | 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 Article Outcomes of a Multimedia Educational Workshop in an Internal Medicine Residency Sahana Venkatesh, Ronald Markert, Brian Elliott, Joseph Glendening, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6205858/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: Effective communication is crucial for medical residents, particularly during morning reports where they present complex medical information. Despite the widespread use of multimedia tools like PowerPoint, formal training on their optimal use is often lacking in residency curricula. Aim: This study aimed to assess the impact of a multimedia educational intervention on resident slide development and perceptions of multimedia use in morning report presentations. Setting: The study was conducted at a university-affiliated medical center. Participants: 27 Internal Medicine residents (34% of the total cohort) participated in the study. Program Description: The intervention consisted of a one-hour workshop covering key theories in audiovisual learning, including dual-channel theory, signaling principle, and the concepts of redundancy and extraneous material. Program Evaluation : 81% of residents reported no prior formal multimedia training. Significant improvements were observed in resident confidence (3.5 to 4.2, p<.001) and perceived importance (3.9 to 4.5, p=0.003) of multimedia use after the workshop. A significant decrease in word count per slide was observed in morning reports (p=0.002), while knowledge of specific multimedia terms showed non-significant improvement. Discussion: This study suggests that even brief multimedia training can positively influence resident presentation practices. Integrating such training into residency curricula could enhance communication skills and the effectiveness of medical education. Health sciences/Medical research Health sciences/Medical research/Outcomes research Multimedia Education Graduate Medical Education Audiovisual Learning Multimedia Theories Figures Figure 1 Figure 2 Introduction Medical residency provides a distinctive opportunity to serve the role of both the learner and educator. Residents are tasked with retaining large amounts of complex information presented by faculty or peers, often during scheduled didactic sessions. Multimedia platforms, such as Microsoft PowerPoint, are routinely used to deliver information to large groups of learners. Unfortunately, despite widespread use, education on the proper function and role of these electronic aids is not often considered. 1 Educational theories in multimedia use provide theoretical frameworks for the effective use of these platforms to support improved presentation delivery and audience retention. 2 What has yet to be explored in graduate medical education is resident perceptions and presentation quality assessed after the implementation of a multimedia training workshop. It has been suggested that students may remember less than ten percent of information when retention is assessed weeks after lecture. 3 Understanding evidence-based theories behind memory formation may assist teachers in constructing presentations effectively for improving audience retention. Richard Mayer serves as a leader in the realm of multimedia learning and his book, The Cambridge Handbook of Multimedia Learning, formed the foundation of our multimedia workshop. The dual channel assumption suggests that information is obtained via audio and visual stimuli. 4 These stimuli are then processed in the brain, where the cognitive theory suggests that information is first stored in the working memory and selective information is then retained in long term memory. 4 The limited capacity assumption suggests that the amount of information that is processed at any time is limited. Cognitive load is the working memory’s efforts to process information. 4 The resources of the working memory can be saturated by an overabundance of information. 4 Many presentations contain large amounts of information, often arbitrarily incorporated by the presenter, which can overwhelm the audience’s cognitive load and limit information transfer and retention. To optimize information transfer to long-term memory, experts found that avoiding redundancy is effective for audiences. 4 For complex topics, subjects perform better when graphics and narration are used without substantial onscreen text than when substantial onscreen text is included, a reflection of the modality principle. 4 Removing extraneous material, or information that is not immediately pertinent to the goal of the slide or presentation (i.e., clip art, sounds, extra words, etc.) results decreases cognitive load and thus increases information retention. This is known as the coherence principle. 4 We sought to create and study a workshop designed to educate Internal Medicine residents on these multimedia educational principles – an intervention that has not been formally pursued to date. The purpose of this study was to determine if an educational workshop on multimedia could improve residents’ knowledge of multimedia principles, their perceptions of presentation value, and the verbosity of their didactic presentations. Setting and Participants This was a prospective before-after cohort study at our university-affiliated Internal Medicine residency program with 79 residents. Program Description A faculty member and chief resident created and delivered a ninety-minute educational workshop during regularly scheduled didactic time in November 2022. The faculty member was formally trained in theories of multimedia presentation delivery and the chief resident received informal training in multimedia theories of presentation delivery. Of 79 residents, 27 were able to attend the workshop (27/79, 34% attendance rate). These 27 participants initially completed an internally validated anonymous pre-survey (27/27, 100% response rate) assessing their baseline knowledge of multimedia educational theories and perceptions of multimedia use (appendix a). They received a thirty-minute presentation on educational theories in information processing and implementable tactics in audiovisual learning followed by a sixty-minute small group session to develop 5-minute multimedia presentations applying these theories. An anonymous post-survey was then distributed to assess residents’ perceptions of confidence and knowledge. Informed consent was obtained from all participants. Survey and Assessment The pre- and post- workshop survey instrument contained 5-point Likert scale ratings to assess perceptions and four questions (two multiple-choice and two true-false) to assess knowledge of multimedia educational theories (appendix a). Residents at our program create 30-minute morning report presentations in groups of three and each resident delivers the presentation at one of the three primary training sites. Of 79 total residents, 18 were scheduled to deliver morning report presentations during December 2022 through April 2023 at a selected site. These presentations were scored by the expert faculty using a structured form (appendix b.) This form assesses morning report content, text, graphics, and delivery and was developed by the authors. The Scholastic Rubric for PowerPoint Presentation was considered a structural example for development of this tool. 5 The written and verbal feedback was given to the residents immediately after the morning report presentation. An anonymous post-feedback perception-based survey was electronically sent to these residents at the completion of the evaluation period (April 2023). Survey completion was voluntary 14/18, 78% response rate). Each morning report presentation was assessed for word count per slide by utilizing the word count feature on PowerPoint and dividing this value by the total number of slides per presentation. Residents are recommended to have board review questions included in their presentations per program requirements, for which word count might vary, and thus, board question slides were excluded from word and slide counts. Statistical Analysis Data were interpreted using Statistical Package for the Social Sciences (SPSS) by International Business Machines (IBM). Survey perceptions were assessed using five-point Likert scale assessment (1=not at all important/confident, 5=extremely important/confident) and interpreted using related-samples Wilcoxon signed rank tests. Multiple choice question improvements were interpreted using the Related-Samples McNemar Change test. Word counts per slide were interpreted using two-sided Mann Whitney Wilcoxon Test. We used Cohen’s d formula to calculate effect size between pre- and post- word count means. All analysis was performed with alpha = 0.05 and power of 0.80. Feasibility Approximately 12 hours were required to develop the initial presentation and 90 -minutes were required for delivery. Each 30-minute morning report session is built into the existing Internal Medicine residency schedule. An extra 10 minutes were spent at the end of each morning report session for the expert faculty member to review the feedback form with the resident. Institution Review Board Statement This study received exempt status approval from the Wright State Institutional Review Board (IRB-2022-105). All procedures were conducted in accordance with relevant ethical guidelines and regulations. Program Evaluation Pre-intervention survey data demonstrated that 81% of residents had never received training in multimedia use before this intervention. Mean resident confidence in the use of multimedia improved from 3.5 to 4.2 (p=0.001) from pre- to post-test assessment. Resident perceptions of the importance of optimal multimedia use demonstrated a significant increase from 3.9 to 4.5 (p=0.005) from pre- to post-test. Residents demonstrated non-significant improvement in answering multiple-choice and true-false questions from 85% correct pre-intervention to 90% post-intervention (p=0.239) Of 18 residents who presented morning reports, 14 responded (14/18, 78% response rate). Of the 14 residents, 92% reported that the immediate feedback was somewhat useful, very useful, or extremely useful. The pre-intervention word count per morning report slide averaged 59.2, which, post-intervention, decreased to an average of 40.0 (Mann-Whitney U=66, n 1 =n 2 =18, p=0.002) with an estimated effect size of 1.2. Discussion We found that a one-time multimedia education intervention improved residents’ perception of presentation value and resulted in a statistically significant decrease in words per slide during morning report presentations. Levels 1 through 3 of Kirkpatrick’s Four-Level Training Evaluation Model were evaluated in the creation, implementation, and evaluation of this curriculum. 6 We discovered that residents found the initial session helpful in presentation delivery confidence and value recognition, reporting increased importance attributable to multimedia quality during a presentation. This suggests an achievement of level 1 goals (reaction) on Kirkpatrick’s Four-Level Training Evaluation model. In assessing level 2 goals, participants were able to better identify Mayer’s multimedia theories when assessed by pre- and post-intervention multiple choice questions, though this improvement was not statistically significant. The longitudinal presentation assessment by an expert faculty member allowed for the reinforcement of key theories with timely, actionable, goal-referenced, and specific feedback. Of note, only one site was chosen for implementation of formative feedback due to expert presence and to reduce evaluator variability for the purposes of this study. Electronic surveys at the completion of the four-month evaluation period suggested that residents found this method of formative assessment to be useful, also achieving level 1 goals on the Kirkpatrick scale. Fewer words per slide on resident-developed teaching PowerPoint slides post-intervention versus pre-intervention suggests an application of Mayer’s multimedia theories taught in the initial session, specifically, the application of the limited capacity assumption and coherence principle. Word count per slide was chosen as an objective measure of change as previous research demonstrates slide design with reduced text and predominant visual evidence leads to improved pre- to post-educational workshoptest results in both short- and long-term retention analysis of professional students. 7 , 8 , 9 This longitudinal evaluation assessed for level 3 change on Kirkpatrick’s Model. Figure 1 demonstrates an example of a slide with a heavy word count (179 words per slide) and was presented as part of a morning report presentation pre-intervention. Figure 2 demonstrates a slide post-intervention with a reduced word count (17 words per slide). The second example demonstrates the application of the coherence principle as there is reduced information per slide with visual spacing in a flow-chart format to not overwhelm the audience members’ cognitive capacities. Our curriculum provides a prospective model for a two-part educational intervention in longitudinal audio-visual presentation training and to our knowledge, is the first of its kind within post-graduate medical training. Limitations of the study exist and offer opportunities for further inquiry. A limitation of the study is that only 41% of the total resident cohort were able to be present at the initial didactic series, largely limited by work duties, which may have limited baseline knowledge formation for subsequent feedback. Formative assessment was not initiated prior to the intervention, barring the comparison of pre- and post-intervention presentation scores. Lastly, only 14 of 18 residents voluntarily offered feedback of the longitudinal evaluation, perhaps allowing for bias in feedback interpretation. Further research might investigate hosting multiple workshops to ensure more robust resident attendance. Additionally, formative assessment might begin before the workshop(s) to assess for a pre- and post- intervention difference in evaluation scores. Our investigation demonstrated that residents are rarely educated on the optimal use of multimedia platforms despite frequent utilization. After an educational workshop, residents were found to associate greater importance and confidence with using multimedia. Longitudinal formative evaluation of morning report presentations was associated with positive resident perception, and word count analysis of resident-developed teaching slides for morning report presentations demonstrated a significantly reduced word count when compared pre- and post-intervention. Results were obtained within one academic year, suggesting that meaningful results can be acquired within the limits of a residency curriculum. This study supports the incorporation of multimedia education in post-graduate medical training. Declarations Disclaimer: The views expressed in this work are those of the authors and do not reflect the official policy or position of the Department of the Army, Navy, Air Force, Department of Defense, or the United States Government. Ethical Approval: Wright State University performed an ethical review of this study, and protocol IRB-2022-105 was approved with a ‘Exempt’ determination. Consent to Publish: The 88 th Medical Group reviewed and cleared our manuscript for publication. Author Contributions: Sahana Venkatesh MD – Project design, IRB approval, implementation, data collection, primary authorship, editing of manuscript. Ronald Markert PhD- Data analysis, editing of manuscript. Brian Elliott, MD. - Implementation, data collection, editing of manuscript. Joey Glendening, DO - Implementation, data collection, editing of manuscript. Kathryn Burtson, MD - Project design, IRB approval, implementation, project oversight, editing of manuscript, corresponding author. Competing Interests: NA Acknowledgements Contributors: NA Funders: NA Prior Presentations: NA Data availability statement: The datasets generated during and/or analyzed during the current study available from the corresponding author on reasonable request. References Zhornitskiy A, Nguyen A, Kaunitz JD. PowerPoint to the People: The Four Secrets to Delivering a Great Medical Talk. Dig Dis Sci. 2020 Jul;65(7):1892-1894. doi: 10.1007/s10620-020-06273-8. PMID: 32335817. Nagmoti JM. Departing from PowerPoint default mode: Applying Mayer's multimedia principles for enhanced learning of parasitology . Indian J Med Microbiol . 2017 Apr-Jun;35(2):199-203. doi: 10.4103/ijmm.IJMM_16_251. PMID: 28681806. Denman M. How to create memorable lectures. Lander University’s White Board . 2011 Sept; 3(9). Mayer, R. & Fiorella, L. (Eds.). (2021). The Cambridge Handbook of Multimedia Learning (3rd ed., Cambridge Handbooks in Psychology). Cambridge: Cambridge University Press. doi:10.1017/9781108894333 Rubric for PowerPoint Presentation- Time Travels. PowerPoint Made Very Easy! Scholastic Inc. https://www.scholastic.com/content/dam/teachers/lesson-plans/migrated-files-in-body/rubic.pdf. Accessed 28 June 2023. Kirkpatrick, D L. (1994). Evaluating Training Programs: The Four Levels. San Francisco: Berrett-Koehler Publishers. Root Kustritz MV. Effect of differing PowerPoint slide design on multiple-choice test scores for assessment of knowledge and retention in a theriogenology course. J Vet Med Educ . 2014;41(3):311-317. doi:10.3138/jvme.0114-004R Alley M., Schreiber, M., and Muffo, J. "Pilot testing of a new design for presentation slides to teach science and engineering," Proceedings Frontiers in Education 35th Annual Conference , Indianopolis, IN, USA, 2005, pp. S3G-7, doi: 10.1109/FIE.2005.1612283. Issa N, Mayer RE, Schuller M, Wang E, Shapiro MB, DaRosa DA. Teaching for understanding in medical classrooms using multimedia design principles. Med Educ. 2013 Apr;47(4):388-96. doi: 10.1111/medu.12127. PMID: 23488758. McCroskey LL, Richmond VP, McCroskey JC. The scholarship of teaching and learning: contributions from the discipline of communication. Communication Education. 2002;51:383–391. Bower MG, Moloney RA, Cavanagh MS, et al. Assessing preservice teachers’ presentation capabilities: contrasting the modes of communication with the constructed impression. Australian Journal of Teacher Education . 2013;38. Available at: https://eric.ed.gov/?q=%22body+language%22+and+presentation&id=EJ1016019. Griffith M, Brown C, Haas MRC, Huang RD, Hopson LR. Educational autopsy: An innovative structured debrief for residency didactic teaching. AEM Educ Train . 2021 Jul 1;5(3):e10628. doi: 10.1002/aet2.10628. PMID: 34222757; PMCID: PMC8239163. Alpert JS. So, You have to give a lecture—are you nervous? Am J Med, 132 (5), May 2019. On Improvement of Scientific Presentations. American Journal of Roentgenology . 2000;174: 1229-1231. 10.2214/ajr.174.5.1741229 Castillo M. Making a point: getting the most out of PowerPoint. Am J Neuroradiol . 2011 Feb;32(2):217-9. doi: 10.3174/ajnr.A2150. Epub 2010 May 20. PMID: 20488906; PMCID: PMC7965697. Grech V. WASP (Write a Scientific Paper): Optimisation of PowerPoint presentations and skills. Early Hum Dev . 2018;125:53-56. doi:10.1016/j.earlhumdev.2018.06.006 Grech V. The application of the Mayer multimedia learning theory to medical PowerPoint slide show presentations. J Vis Commun Med. 2018 Jan;41(1):36-41. doi: 10.1080/17453054.2017.1408400. PMID: 29381105. Kalyuga, S., Chandler, P., & Sweller, J. (1999). Managing split-attention and redundancy in multimedia instruction. Appl Cogn Psychol , 13(4), 351–371. https://doi.org/10.1002/(SICI)1099-0720(199908)13:43.0.CO;2-6 Additional Declarations No competing interests reported. Supplementary Files Appendixa.doc Appendixb.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-6205858","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":434161705,"identity":"8eaf6d9b-5506-47e2-8ee6-82d259e3e670","order_by":0,"name":"Sahana Venkatesh","email":"","orcid":"","institution":"Wright State University","correspondingAuthor":false,"prefix":"","firstName":"Sahana","middleName":"","lastName":"Venkatesh","suffix":""},{"id":434161706,"identity":"3ea044d1-1720-4682-8f6f-ebbcfe372a05","order_by":1,"name":"Ronald Markert","email":"","orcid":"","institution":"Wright State 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2","display":"","copyAsset":false,"role":"figure","size":79627,"visible":true,"origin":"","legend":"\u003cp\u003eEnhancing Information Delivery: Post-Intervention Slide Example (17 words).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6205858/v1/7a439ae4de2fbc6f6c5c4dcc.png"},{"id":97671893,"identity":"e2ca5985-0a9f-4e87-9025-9b08edc6dd1f","added_by":"auto","created_at":"2025-12-08 09:33:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":792890,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6205858/v1/7249bd38-72c6-4a45-b6eb-ad1f91a3267b.pdf"},{"id":79836492,"identity":"2bb97271-397e-4368-9dcb-3f9a8d48bb84","added_by":"auto","created_at":"2025-04-03 11:24:52","extension":"doc","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":57893,"visible":true,"origin":"","legend":"","description":"","filename":"Appendixa.doc","url":"https://assets-eu.researchsquare.com/files/rs-6205858/v1/542abb0dc5d9529bffaac877.doc"},{"id":79835397,"identity":"45b3f19c-57f7-42b4-8862-7b5826654c6a","added_by":"auto","created_at":"2025-04-03 11:16:52","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":23605,"visible":true,"origin":"","legend":"","description":"","filename":"Appendixb.docx","url":"https://assets-eu.researchsquare.com/files/rs-6205858/v1/7588e91bab18a494e00838a5.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Outcomes of a Multimedia Educational Workshop in an Internal Medicine Residency","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMedical residency provides a distinctive opportunity to serve the role of both the learner and educator. Residents are tasked with retaining large amounts of complex information presented by faculty or peers, often during scheduled didactic sessions. Multimedia platforms, such as Microsoft PowerPoint, are routinely used to\u0026nbsp;deliver information to large groups of learners. Unfortunately, despite widespread use,\u0026nbsp;education on the proper function and role of these electronic aids is not often considered.\u003csup\u003e1\u003c/sup\u003e Educational theories in multimedia use provide theoretical frameworks for the effective use of these platforms to support improved presentation delivery and audience retention.\u003csup\u003e2\u0026nbsp;\u003c/sup\u003eWhat has yet to be explored in graduate medical education is resident perceptions and presentation quality assessed after the implementation of a multimedia training workshop.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt has been suggested that students may remember less than ten percent of information when retention is assessed weeks after lecture.\u003csup\u003e3\u003c/sup\u003e Understanding evidence-based theories behind memory formation may assist teachers in constructing presentations effectively for improving audience retention. Richard Mayer serves as a leader in the realm of multimedia learning and his book, The Cambridge Handbook of Multimedia Learning, formed the foundation of our multimedia workshop. The dual channel assumption suggests that information is obtained via audio and\u0026nbsp;visual stimuli.\u003csup\u003e4\u003c/sup\u003e These stimuli are then processed in the brain, where the cognitive theory suggests that information is first stored in the working memory and selective information is then retained in long term memory.\u003csup\u003e4\u003c/sup\u003e The limited capacity assumption suggests that the amount of information that is processed at any time is limited. Cognitive load is the working memory\u0026rsquo;s efforts to process information.\u003csup\u003e4\u003c/sup\u003e The resources of the working memory can be saturated by an overabundance of information.\u003csup\u003e4\u003c/sup\u003e Many presentations contain large amounts of information, often arbitrarily incorporated by the presenter, which can overwhelm the audience\u0026rsquo;s cognitive load and limit information transfer and retention.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo optimize information transfer to long-term memory, experts found that avoiding redundancy is effective for audiences.\u003csup\u003e4\u003c/sup\u003e For complex topics, subjects perform better when graphics and narration are used without substantial onscreen text than when substantial onscreen text is included, a reflection of the modality principle.\u003csup\u003e4\u003c/sup\u003e\u0026nbsp; Removing extraneous material, or information that is not immediately pertinent to the goal of the slide or presentation (i.e., clip art, sounds, extra words, etc.) results decreases cognitive load and thus increases information retention. This is known as the coherence principle.\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eWe sought to create and study a workshop designed to educate\u0026nbsp;Internal Medicine residents on these multimedia educational principles \u0026ndash; an intervention that has not been formally pursued to date. The purpose of this study was to\u0026nbsp;determine if an educational workshop on multimedia could\u0026nbsp;improve residents\u0026rsquo; knowledge of multimedia principles, their perceptions of presentation value,\u0026nbsp;and the verbosity of their didactic presentations. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting and Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a\u0026nbsp;prospective before-after cohort study at our\u0026nbsp;university-affiliated Internal Medicine residency program with 79\u0026nbsp;residents.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProgram Description\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA faculty member and\u0026nbsp;chief resident created and delivered a ninety-minute educational\u0026nbsp;workshop during regularly scheduled didactic time\u0026nbsp;in November 2022. The faculty member was formally trained in theories of multimedia presentation delivery and the chief resident received informal training in multimedia theories of presentation delivery. Of 79 residents, 27 were able to attend the\u0026nbsp;workshop (27/79, 34% attendance rate). These 27\u0026nbsp;participants initially completed an internally validated anonymous pre-survey (27/27, 100% response rate) assessing their baseline knowledge of multimedia educational theories and\u0026nbsp;perceptions of multimedia use (appendix a). They received a thirty-minute presentation on educational theories in information processing and implementable tactics in audiovisual learning followed by a sixty-minute small group session to develop 5-minute multimedia presentations applying these theories. An anonymous post-survey was then distributed to assess residents\u0026rsquo;\u0026nbsp;perceptions of confidence and knowledge. Informed consent was obtained from all participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSurvey and Assessment\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe pre- and post- workshop survey instrument contained\u0026nbsp;5-point Likert scale\u0026nbsp;ratings to assess perceptions and four questions (two multiple-choice and two true-false) to assess knowledge of multimedia educational theories (appendix a).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResidents at our program create 30-minute morning report presentations in groups of three and each resident delivers the presentation at one of the three primary training sites. Of 79 total residents, 18 were scheduled to deliver morning report presentations\u0026nbsp;during December 2022 through April 2023 at a selected site. These presentations were scored by the expert faculty using a structured form (appendix b.) This form assesses morning report content, text, graphics, and delivery and was developed by the authors. The Scholastic Rubric for PowerPoint Presentation was considered a structural example for development of this tool.\u003csup\u003e5\u0026nbsp;\u003c/sup\u003eThe written and verbal feedback was given to the residents immediately after the morning report presentation. An anonymous post-feedback perception-based survey was electronically sent to these residents at the completion of the evaluation period (April 2023). Survey completion was voluntary 14/18, 78% response rate).\u003c/p\u003e\n\u003cp\u003eEach morning report presentation was assessed for word count per slide by utilizing the \u003cem\u003eword count\u003c/em\u003e feature on PowerPoint and dividing this value by the total number of slides per presentation. Residents are recommended to have board review questions included in their presentations per program requirements, for which word count might vary, and thus, board question slides were excluded from word and slide counts. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical Analysis\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData were interpreted using Statistical Package for the Social Sciences (SPSS) by International Business Machines (IBM). Survey perceptions were assessed using five-point Likert scale assessment (1=not at all important/confident, 5=extremely important/confident) and\u0026nbsp;interpreted using related-samples Wilcoxon signed rank tests. Multiple choice question improvements were interpreted using the Related-Samples McNemar Change test. Word counts per slide were interpreted using two-sided Mann Whitney Wilcoxon Test. We used Cohen\u0026rsquo;s d formula to calculate effect size between pre- and post- word count means. All analysis was performed with alpha = 0.05 and power of 0.80.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFeasibility\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eApproximately 12 hours were required to develop the initial presentation and 90 -minutes were required for delivery. Each 30-minute morning report session is built into the existing Internal Medicine residency schedule. An extra 10 minutes were spent at the end of each morning report session for the expert faculty member to review the feedback form with the resident.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInstitution Review Board Statement\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study received exempt status approval from the Wright State Institutional Review Board (IRB-2022-105). All procedures were conducted in accordance with relevant ethical guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProgram Evaluation \u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePre-intervention survey data\u0026nbsp;demonstrated that 81% of residents had never received training in multimedia use before this intervention. Mean resident confidence in the use of multimedia improved from 3.5 to 4.2 (p=0.001) from pre- to post-test assessment. \u0026nbsp;Resident\u0026nbsp;perceptions of the importance of optimal multimedia use demonstrated a significant increase from 3.9 to 4.5 (p=0.005) from pre- to post-test. Residents demonstrated non-significant improvement in answering multiple-choice and true-false questions from 85% correct pre-intervention to 90% post-intervention (p=0.239)\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOf 18 residents who presented morning reports, 14 responded (14/18, 78% response rate). Of the 14 residents, 92% reported that the immediate feedback was somewhat useful, very useful, or extremely useful.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe pre-intervention word count per morning report slide averaged 59.2, which, post-intervention, decreased to an average of 40.0 (Mann-Whitney U=66, n\u003csub\u003e1\u003c/sub\u003e=n\u003csub\u003e2\u003c/sub\u003e=18, p=0.002) with an estimated effect size of 1.2.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe found that a one-time multimedia education intervention improved residents\u0026rsquo; perception of presentation value and resulted in a statistically significant decrease in words per slide during morning report presentations. Levels 1 through 3 of Kirkpatrick\u0026rsquo;s Four-Level Training Evaluation Model were evaluated in the creation, implementation, and evaluation of this curriculum.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e We discovered that residents found the initial session helpful in presentation delivery confidence and value recognition, reporting increased importance attributable to multimedia quality during a presentation. This suggests an achievement of level 1 goals (reaction) on Kirkpatrick\u0026rsquo;s Four-Level Training Evaluation model. In assessing level 2 goals, participants were able to better identify Mayer\u0026rsquo;s multimedia theories when assessed by pre- and post-intervention multiple choice questions, though this improvement was not statistically significant. The longitudinal presentation assessment by an expert faculty member allowed for the reinforcement of key theories with timely, actionable, goal-referenced, and specific feedback. Of note, only one site was chosen for implementation of formative feedback due to expert presence and to reduce evaluator variability for the purposes of this study. Electronic surveys at the completion of the four-month evaluation period suggested that residents found this method of formative assessment to be useful, also achieving level 1 goals on the Kirkpatrick scale.\u003c/p\u003e \u003cp\u003eFewer words per slide on resident-developed teaching PowerPoint slides post-intervention versus pre-intervention suggests an application of Mayer\u0026rsquo;s multimedia theories taught in the initial session, specifically, the application of the limited capacity assumption and coherence principle. Word count per slide was chosen as an objective measure of change as previous research demonstrates slide design with reduced text and predominant visual evidence leads to improved pre- to post-educational workshoptest results in both short- and long-term retention analysis of professional students.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e This longitudinal evaluation assessed for level 3 change on Kirkpatrick\u0026rsquo;s Model. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e demonstrates an example of a slide with a heavy word count (179 words per slide) and was presented as part of a morning report presentation pre-intervention. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e demonstrates a slide post-intervention with a reduced word count (17 words per slide). The second example demonstrates the application of the coherence principle as there is reduced information per slide with visual spacing in a flow-chart format to not overwhelm the audience members\u0026rsquo; cognitive capacities. Our curriculum provides a prospective model for a two-part educational intervention in longitudinal audio-visual presentation training and to our knowledge, is the first of its kind within post-graduate medical training.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eLimitations of the study exist and offer opportunities for further inquiry. A limitation of the study is that only 41% of the total resident cohort were able to be present at the initial didactic series, largely limited by work duties, which may have limited baseline knowledge formation for subsequent feedback. Formative assessment was not initiated prior to the intervention, barring the comparison of pre- and post-intervention presentation scores. Lastly, only 14 of 18 residents voluntarily offered feedback of the longitudinal evaluation, perhaps allowing for bias in feedback interpretation. Further research might investigate hosting multiple workshops to ensure more robust resident attendance. Additionally, formative assessment might begin before the workshop(s) to assess for a pre- and post- intervention difference in evaluation scores. \u003c/p\u003e \u003cp\u003eOur investigation demonstrated that residents are rarely educated on the optimal use of multimedia platforms despite frequent utilization. After an educational workshop, residents were found to associate greater importance and confidence with using multimedia. Longitudinal formative evaluation of morning report presentations was associated with positive resident perception, and word count analysis of resident-developed teaching slides for morning report presentations demonstrated a significantly reduced word count when compared pre- and post-intervention. Results were obtained within one academic year, suggesting that meaningful results can be acquired within the limits of a residency curriculum. This study supports the incorporation of multimedia education in post-graduate medical training.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDisclaimer:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The views expressed in this work are those of the authors and do not reflect the official policy or position of the Department of the Army, Navy, Air Force, Department of Defense, or the United States Government.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u0026nbsp;\u003c/strong\u003eWright State University performed an ethical review of this study, and protocol IRB-2022-105\u0026nbsp;was approved with a \u0026lsquo;Exempt\u0026rsquo; determination.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish:\u0026nbsp;\u003c/strong\u003eThe 88\u003csup\u003eth\u003c/sup\u003e Medical Group reviewed and cleared our manuscript for publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003cbr\u003e\u003c/strong\u003eSahana Venkatesh MD \u0026ndash; Project design, IRB approval, implementation, data collection, primary authorship, editing of manuscript.\u0026nbsp;\u003cbr\u003e\u0026nbsp;Ronald Markert\u0026nbsp;PhD-\u0026nbsp;Data analysis, editing of manuscript.\u0026nbsp;\u003cbr\u003eBrian Elliott, MD.\u003csup\u003e\u0026nbsp;\u003c/sup\u003e- Implementation, data collection, editing of manuscript.\u0026nbsp;\u003cbr\u003e\u0026nbsp;Joey Glendening, DO\u0026nbsp;-\u0026nbsp;Implementation, data collection, editing of manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eKathryn Burtson, MD\u003csup\u003e\u0026nbsp;\u003c/sup\u003e- Project design, IRB approval, implementation, project oversight, editing of manuscript, corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u0026nbsp;\u003c/strong\u003eNA\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eContributors:\u0026nbsp;\u003c/strong\u003eNA\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFunders:\u0026nbsp;\u003c/strong\u003eNA\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePrior Presentations:\u0026nbsp;\u003c/strong\u003eNA\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eZhornitskiy A, Nguyen A, Kaunitz JD. PowerPoint to the People: The Four Secrets to Delivering a Great Medical Talk. \u003cem\u003eDig Dis Sci.\u003c/em\u003e 2020 Jul;65(7):1892-1894. doi: 10.1007/s10620-020-06273-8. PMID: 32335817. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eNagmoti JM. Departing from PowerPoint default mode: Applying Mayer\u0026apos;s multimedia principles for enhanced learning of parasitology\u003cem\u003e. Indian J Med Microbiol\u003c/em\u003e. 2017 Apr-Jun;35(2):199-203. doi: 10.4103/ijmm.IJMM_16_251. PMID: 28681806. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDenman M. How to create memorable lectures. \u003cem\u003eLander University\u0026rsquo;s White Board\u003c/em\u003e\u003cem\u003e.\u0026nbsp;\u003c/em\u003e2011 Sept; 3(9). \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMayer, R. \u0026amp; Fiorella, L. (Eds.). (2021).\u0026nbsp;\u003cem\u003eThe Cambridge Handbook of Multimedia Learning\u003c/em\u003e (3rd ed., Cambridge Handbooks in Psychology). Cambridge: Cambridge University Press. doi:10.1017/9781108894333\u003c/li\u003e\n \u003cli\u003eRubric for PowerPoint Presentation- Time Travels. \u003cem\u003ePowerPoint Made Very Easy!\u003c/em\u003e Scholastic Inc. https://www.scholastic.com/content/dam/teachers/lesson-plans/migrated-files-in-body/rubic.pdf. \u003cem\u003eAccessed 28 June 2023.\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eKirkpatrick, D L. (1994). Evaluating Training Programs: The Four Levels. San Francisco: Berrett-Koehler Publishers.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRoot Kustritz MV. Effect of differing PowerPoint slide design on multiple-choice test scores for assessment of knowledge and retention in a theriogenology course. \u003cem\u003eJ Vet Med Educ\u003c/em\u003e. 2014;41(3):311-317. doi:10.3138/jvme.0114-004R\u003c/li\u003e\n \u003cli\u003eAlley M., Schreiber, M., and Muffo, J. \u0026quot;Pilot testing of a new design for presentation slides to teach science and engineering,\u0026quot; \u003cem\u003eProceedings Frontiers in Education 35th Annual Conference\u003c/em\u003e, Indianopolis, IN, USA, 2005, pp. S3G-7, doi: 10.1109/FIE.2005.1612283. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eIssa N, Mayer RE, Schuller M, Wang E, Shapiro MB, DaRosa DA. Teaching for understanding in medical classrooms using multimedia design principles. \u003cem\u003eMed Educ.\u003c/em\u003e 2013 Apr;47(4):388-96. doi: 10.1111/medu.12127. PMID: 23488758.\u003c/li\u003e\n \u003cli\u003eMcCroskey LL, Richmond VP, McCroskey JC. The scholarship of teaching and learning: contributions from the discipline of communication. \u003cem\u003eCommunication Education.\u003c/em\u003e 2002;51:383\u0026ndash;391. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBower MG, Moloney RA, Cavanagh MS, et al. Assessing preservice teachers\u0026rsquo; presentation capabilities: contrasting the modes of communication with the constructed impression. \u003cem\u003eAustralian Journal of Teacher Education\u003c/em\u003e. 2013;38. Available at: https://eric.ed.gov/?q=%22body+language%22+and+presentation\u0026amp;id=EJ1016019. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGriffith M, Brown C, Haas MRC, Huang RD, Hopson LR. Educational autopsy: An innovative structured debrief for residency didactic teaching. \u003cem\u003eAEM Educ Train\u003c/em\u003e. 2021 Jul 1;5(3):e10628. doi: 10.1002/aet2.10628. PMID: 34222757; PMCID: PMC8239163. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAlpert JS. So, You have to give a lecture\u0026mdash;are you nervous? \u003cem\u003eAm J Med,\u0026nbsp;\u003c/em\u003e132 (5), May 2019. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOn Improvement of Scientific Presentations. \u003cem\u003eAmerican Journal of Roentgenology\u003c/em\u003e. 2000;174: 1229-1231. 10.2214/ajr.174.5.1741229 \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCastillo M. Making a point: getting the most out of PowerPoint. \u003cem\u003eAm J Neuroradiol\u003c/em\u003e. 2011 Feb;32(2):217-9. doi: 10.3174/ajnr.A2150. Epub 2010 May 20. PMID: 20488906; PMCID: PMC7965697. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGrech V. WASP (Write a Scientific Paper): Optimisation of PowerPoint presentations and skills. \u003cem\u003eEarly Hum Dev\u003c/em\u003e. 2018;125:53-56. doi:10.1016/j.earlhumdev.2018.06.006\u003c/li\u003e\n \u003cli\u003eGrech V. The application of the Mayer multimedia learning theory to medical PowerPoint slide show presentations. \u003cem\u003eJ Vis Commun Med.\u003c/em\u003e 2018 Jan;41(1):36-41. doi: 10.1080/17453054.2017.1408400. PMID: 29381105. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKalyuga, S., Chandler, P., \u0026amp; Sweller, J. (1999). Managing split-attention and redundancy in multimedia instruction. \u003cem\u003eAppl Cogn Psychol\u003c/em\u003e, 13(4), 351\u0026ndash;371. https://doi.org/10.1002/(SICI)1099-0720(199908)13:4\u0026lt;351::AID-ACP589\u0026gt;3.0.CO;2-6\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"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":"Multimedia Education, Graduate Medical Education, Audiovisual Learning, Multimedia Theories ","lastPublishedDoi":"10.21203/rs.3.rs-6205858/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6205858/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Effective communication is crucial for medical residents, particularly during morning reports where they present complex medical information. Despite the widespread use of multimedia tools like PowerPoint, formal training on their optimal use is often lacking in residency curricula.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e This study aimed to assess the impact of a multimedia educational intervention on resident slide development and perceptions of multimedia use in morning report presentations. Setting: The study was conducted at a university-affiliated medical center.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants:\u003c/strong\u003e 27 Internal Medicine residents (34% of the total cohort) participated in the study. Program Description: The intervention consisted of a one-hour workshop covering key theories in audiovisual learning, including dual-channel theory, signaling principle, and the concepts of redundancy and extraneous material.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProgram Evaluation\u003c/strong\u003e: 81% of residents reported no prior formal multimedia training. Significant improvements were observed in resident confidence (3.5 to 4.2, p\u0026lt;.001) and perceived importance (3.9 to 4.5, p=0.003) of multimedia use after the workshop. A significant decrease in word count per slide was observed in morning reports (p=0.002), while knowledge of specific multimedia terms showed non-significant improvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion:\u003c/strong\u003e This study suggests that even brief multimedia training can positively influence resident presentation practices. Integrating such training into residency curricula could enhance communication skills and the effectiveness of medical education.\u003c/p\u003e","manuscriptTitle":"Outcomes of a Multimedia Educational Workshop in an Internal Medicine Residency","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-03 11:16:46","doi":"10.21203/rs.3.rs-6205858/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":"3ac53655-ee2f-4904-a9bc-f56b1f837a57","owner":[],"postedDate":"April 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":46229199,"name":"Health sciences/Medical research"},{"id":46229200,"name":"Health sciences/Medical research/Outcomes research"}],"tags":[],"updatedAt":"2025-12-05T15:24:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-03 11:16:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6205858","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6205858","identity":"rs-6205858","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}