Evidence supporting a virtual case-based module to improve cognitive foundation for the management of laparoscopic appendectomy

Case-based learning (CBL) is an established clinical learning approach, where learners apply knowledge within real-world scenarios. Little evidence exists on applicability of virtual CBL among surgical learners, particularly in low- and middle-income countries (LMICs).

An 18-item interactive, web-based CBL module and 10-item pre/post-module quiz assessing knowledge of acute appendicitis laparoscopic management was created. The module was validated by Ethiopian, Cameroonian, and US surgeons and a psychometrician for content, relevance, and clarity. Twenty-two participants categorized as novice (n = 14), intermediate (n = 5), and expert (n = 3) across three sites (Ethiopia, Cameroon, US) completed the module. Comparisons across pre- and post-module summed scores and experience levels were performed using paired student-test, and one-way ANOVA, respectively, while item-level analyses were performed using a Rasch model.

Significant improvement in mean summed scores from pre- to post-quiz was observed for novice (P < 0.001) and intermediate participants (P = 0.032). Summed scores discriminated novice (M = 6.67), intermediate (M = 8.67), and expert (M = 8.83) participants, P < 0.001. Statistical differences in mean summed scores across sites were confirmed, (M_UM = 5.38, M_Other = 8.50, M_Soddo = 8.08, M_Mbingo = 8.50), P < 0.001, with adequate distribution of difficulty across quiz items, demonstrated by 2 questions that were rated most difficult, 2 rated easy, and 6 rated intermediate.

Our findings suggest that using a virtual, interactive CBL module could improve understanding of laparoscopic appendectomy management in low-resource settings, particularly among early career surgeons and trainees. This system could provide extra benefit in LMICs, where faculty experts are rare. Future studies could focus on validating CBL modules covering technical aspects of laparoscopic appendectomy.