Advances in Health Sciences Education

, Volume 21, Issue 4, pp 789–802 | Cite as

E-learning optimization: the relative and combined effects of mental practice and modeling on enhanced podcast-based learning—a randomized controlled trial

  • Fahad AlamEmail author
  • Sylvain Boet
  • Dominique Piquette
  • Anita Lai
  • Christopher P. Perkes
  • Vicki R. LeBlanc


Enhanced podcasts increase learning, but evidence is lacking on how they should be designed to optimize their effectiveness. This study assessed the impact two learning instructional design methods (mental practice and modeling), either on their own or in combination, for teaching complex cognitive medical content when incorporated into enhanced podcasts. Sixty-three medical students were randomised to one of four versions of an airway management enhanced podcast: (1) control: narrated presentation; (2) modeling: narration with video demonstration of skills; (3) mental practice: narrated presentation with guided mental practice; (4) combined: modeling and mental practice. One week later, students managed a manikin-based simulated airway crisis. Knowledge acquisition was assessed by baseline and retention multiple-choice quizzes. Two blinded raters assessed all videos obtained from simulated crises to measure the students’ skills using a key-elements scale, critical error checklist, and the Ottawa global rating scale (GRS). Baseline knowledge was not different between all four groups (p = 0.65). One week later, knowledge retention was significantly higher for (1) both the mental practice and modeling group than the control group (p = 0.01; p = 0.01, respectively) and (2) the combined mental practice and modeling group compared to all other groups (all ps = 0.01). Regarding skills acquisition, the control group significantly under-performed in comparison to all other groups on the key-events scale (all ps ≤ 0.05), the critical error checklist (all ps ≤ 0.05), and the Ottawa GRS (all ps ≤ 0.05). The combination of mental practice and modeling led to greater improvement on the key events checklist (p = 0.01) compared to either strategy alone. However, the combination of the two strategies did not result in any further learning gains on the two other measures of clinical performance (all ps > 0.05). The effectiveness of enhanced podcasts for knowledge retention and clinical skill acquisition is increased with either mental practice or modeling. The combination of mental practice and modeling had synergistic effects on knowledge retention, but conveyed less clear advantages in its application through clinical skills.


Curriculum design E-learning Instructional design Learning strategies Medical education Mental practice Modeling Mobile learning Podcasts Simulation 



The authors thank Roger Chow and Agnes Ryzynski for their great support in the data collection for this study. They have both given written confirmation for this acknowledgement.


This work was supported by: (1) Education Initiatives in Residency Education Grant (EIRE)—Faculty of Medicine, University of Ottawa, Ottawa, Canada: Funds were used for data collection, specifically to purchase technological equipment such as Apple iPads. Funds were used to cover expenses incurred presenting preliminary results at the annual Association for Medical Education (AMEE) conference in August 2012. (2) Allan Waters Patient Family Simulation Centre, St. Michael’s Hospital, Toronto, Canada, and the Anaesthesia Departments at The University of Toronto, Toronto, Canada and the University of Ottawa, Ottawa, Canada.: Funds provided were used for data collection, specifically for simulation time only.

Author contributions

FA: Study design, conduct, recruitment, data collection, management, analysis and interpretation, first draft of manuscript and subsequent edits. SB: Study design, analysis and interpretation, and manuscript edits. DP: Study design, and manuscript edits. AL: Rating videos and manuscript edits. CP: Rating videos and manuscript edits. VL: Study design, analysis and interpretation, and manuscript edits.

Compliance with ethical standards

Conflict of interests

None of the authors have any interests to declare.


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Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Fahad Alam
    • 1
    • 5
    Email author
  • Sylvain Boet
    • 2
  • Dominique Piquette
    • 3
    • 5
  • Anita Lai
    • 4
  • Christopher P. Perkes
    • 7
  • Vicki R. LeBlanc
    • 6
  1. 1.Department of Anaesthesia, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
  2. 2.Department of Anaesthesia and Department of Innovation in Medical Innovation, The Ottawa HospitalUniversity of OttawaOttawaCanada
  3. 3.Department of Critical CareSunnybrook Health Sciences CentreTorontoCanada
  4. 4.Department of Emergency Medicine, The Ottawa HospitalUniversity of OttawaOttawaCanada
  5. 5.The Wilson Centre for Research in EducationTorontoCanada
  6. 6.Department of Innovation in Medical Education and University of Ottawa Skills and Simulation Centre, The Ottawa HospitalUniversity of OttawaOttawaCanada
  7. 7.Belleville General HospitalBellevilleCanada

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