Outcomes of a Multimedia Educational Workshop in an Internal Medicine Residency

Abstract

Background

Effective communication is crucial for medical residents, especially during foundational didactic sessions where residents present complex medical information. Despite the widespread use of multimedia tools such as PowerPoint, formal training in their optimal use is often lacking in residency curricula.

Aim

This study assessed the impact of a multimedia educational intervention on resident presentation development and perceptions of multimedia use in foundational didactic sessions.

Methods

Interventional, single-group pre- and post-study using a convenience sample of residents at a university-affiliated Internal Medicine residency. Twenty-seven of 79 residents attended a 90-minute multimedia education workshop and completed pre- and post-surveys assessing knowledge and perceptions. Eighteen residents delivered foundational didactics scored by expert faculty. Word counts per slide were analyzed.

Results

81% of residents reported no prior formal multimedia training. Significant improvements were observed in resident confidence (3.5 to 4.2, p=0.001) and perceived importance (3.9 to 4.5, p=0.005) of multimedia use after the workshop. A significant decrease in word count per slide was observed in foundational didactic sessions (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.

Introduction

Medical residency is one of the few learning environments in which trainees function simultaneously as learners and teachers. Residents are expected to absorb large volumes of complex clinical information while also delivering educational content to peers and faculty, most often through formal didactic presentations. Multimedia platforms, particularly Microsoft PowerPoint, have become the default modality for these sessions. Despite their ubiquity, residents receive little to no formal training in using these tools effectively to support learning. ¹ As a result, presentations frequently prioritize content quantity over instructional design, with unclear consequences for learner engagement and knowledge retention.

This gap is especially concerning given the longstanding evidence that lecture-based instruction is vulnerable to rapid learning decay. Students may retain less than 10% of presented information when recall is assessed weeks after a lecture. ² For residency program leaders charged with maximizing educational value within limited protected time, improving the effectiveness of existing teaching formats, rather than adding new curricular demands, represents a high-yield opportunity. Educational theory offers practical, evidence-based guidance for optimizing multimedia presentations, yet these principles are rarely translated into resident-facing faculty development or teaching skills curricula. ³

Richard Mayer’s work in multimedia learning provides a robust theoretical foundation for understanding how learners process and retain information. The dual-channel assumption posits that learners process information through separate auditory and visual channels. ⁴ Information first enters working memory, where only selected elements are encoded into long-term memory. Because working memory has limited capacity, excessive or poorly designed multimedia content can overwhelm learners and impede learning, a phenomenon described as cognitive load. ⁴ In practice, many educational presentations inadvertently exceed this capacity by including dense text, redundant narration, or extraneous visual elements, thereby reducing information transfer and retention.

Several evidence-based multimedia principles offer clear strategies to mitigate cognitive overload. Avoiding redundancy, such as reading verbatim from text-heavy slides, improves learning outcomes. ⁴ For complex material, learners perform better when narration is paired with relevant graphics rather than extensive on-screen text, consistent with the modality principle. ⁴ Similarly, removing extraneous material that does not directly support instructional goals, such as decorative images, unnecessary animations, or superfluous text, reduces cognitive load and enhances retention, a concept known as the coherence principle. ⁴

Despite the strength of this theoretical and empirical foundation, little is known about how structured training in multimedia principles influences residents’ teaching practices in graduate medical education. Specifically resident perceptions of presentation value and measurable changes in presentation design following such training have not been well studied. To address this gap, we developed and evaluated a pragmatic workshop designed to teach Internal Medicine residents core multimedia learning principles grounded in Mayer’s framework. The purpose of this study was to determine whether a brief educational intervention could improve residents’ knowledge of multimedia principles, their perceptions of didactic presentations, and the verbosity of their own teaching materials.

Methods

Setting and Participants

We used a single-group, pretest-posttest (pre-experimental) design with a convenience sample of residents on rotations requiring didactic participation at our university-affiliated Internal Medicine residency program. The inclusion criterion was being a resident on a rotation that included regularly scheduled, protected time for didactics during the November 2022 study period. The exclusion criterion was being on a rotation that precluded didactic attendance, such as an Intensive Care Unit (ICU) rotation, night float, a scheduled vacation, or being on sick leave.

Program Description

A faculty member and a chief resident, both with training in multimedia presentation theory, created and delivered a 90-minute educational workshop during regularly scheduled didactic time in November 2022. Of 79 eligible residents, 27 attended (34% attendance rate), and informed consent was obtained from all participants. The intervention was designed to be a feasible program within the time constraints of a residency schedule, with its assessment process guided by the principles of the 2018 Ottawa Consensus Framework. In line with this framework, we prioritized operational feasibility, the delivery of timely and ongoing feedback, and the assessment’s educational catalytic effect. ⁵

The workshop began with a 30-minute interactive presentation delivered via Prezi. The specific learning objectives were for residents to be able to describe core principles of multimedia and cognitive load theory, critique common slide design flaws, and apply evidence-based principles to their own presentations. To achieve these objectives, instructional materials included a direct comparison of poorly designed, text-heavy slides with optimally-designed examples that used high-impact visuals and minimal text. This didactic portion was immediately followed by a 60-minute, hands-on small-group session. The structure of this activity involved dividing residents into groups of 4-5 and tasking them with creating a brief, five-slide multimedia presentation on an assigned clinical topic, thereby applying the theories just discussed. A faculty member and chief resident facilitated this process, rotating between groups to provide guidance. At the conclusion of the activity, each group presented its work and received immediate peer and instructor feedback. Following the workshop, a survey that assessed residents’ knowledge and perceptions of confidence was completed anonymously.

Survey and Assessment

The pre- and post-workshop survey instrument contained four questions (two multiple-choice and two true-false) to evaluate knowledge of multimedia educational theories and a five-point scale to assess perceptions and (Appendix A).

Residents in our program create 30-minute foundational didactic sessions employing multimedia platforms in groups of three, and each resident delivers the presentation at one of the three primary training sites. Of the 79 total residents, 18 were scheduled to deliver foundational didactic sessions at a selected site from December 2022 through April 2023. These presentations were scored by the expert faculty using a structured form (Appendix B). This form, which the authors developed, assesses foundational didactic content, text, graphics, and delivery. The Scholastic Rubric for PowerPoint Presentation was considered a structural example for creating this tool (Scholastic Inc.). ⁶ Written and oral feedback was given to the residents immediately after the foundational didactic presentation. An anonymous, perception-based, post-feedback survey was electronically sent to these residents after the evaluation period (April 2023). Survey completion was voluntary, 14/18 (78% response rate).

Each foundational didactic session was assessed for word count per slide using the word count feature in PowerPoint, and then this value was divided by the total number of slides in the presentation. Per a program requirement, residents must include American Board of Internal Medicine (ABIM) review questions in their presentations. Since the word counts of ABIM questions vary widely, these question slides were excluded from the study.

Statistical Analysis

The study adopted a pragmatic approach focused on feasibility with an available sample. Thus, a priori sample size calculation was not performed. International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) was used to analyze data. Given the ordinal nature of the survey data and a sample size that was not assumed to have a normal distribution, non-parametric tests were selected.

Survey perceptions were assessed using a five-point scale (1 = not at all important/confident, 5 = extremely important/confident) and were analyzed using the related-samples Wilcoxon Signed-Rank Test. Improvements in the categorical multiple-choice questions were evaluated using the related-samples McNemar’s Change Test. Word counts per slide, representing paired pre- and post-intervention data, were also analyzed using the related-samples Wilcoxon Signed-Rank Test. Cohen’s d was calculated to estimate the effect size for the change in word count. All analyses were performed with a significance level (alpha) set at 0.05.

Feasibility

Approximately 12 hours were required to develop the initial presentation, and 90 minutes to deliver it. Each 30-minute foundational didactic session is built into the existing Internal Medicine Residency schedule. An extra 10 minutes were spent at the end of each foundational didactic session for the expert faculty member to review the feedback form with the resident.

Results

Pre-intervention survey data showed that 81% of residents had never received training in multimedia educational theories. Mean resident confidence in understanding these theories improved from 3.5 to 4.2 (p=0.001) between pre- and post-test assessments. Resident perceptions of the importance of optimal multimedia use increased significantly from 3.9 to 4.5 (p=0.005) between pre- and post-tests. There was no statistically significant change in knowledge scores, as measured by multiple-choice and true-false questions, with the proportion of correct answers changing from 85% pre-intervention to 90% post-intervention (p=0.239).Of 18 residents who presented foundational didactic sessions, 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 foundational didactic session slide averaged 59.2, which, post-intervention, decreased to an average of 40.0 (Mann-Whitney U=66, n₁=n₂=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 foundational didactic sessions. Levels 1 through 3 of Kirkpatrick’s Four-Level Training Evaluation Model were evaluated in the creation, implementation, and evaluation of this curriculum. ⁷ We discovered that residents found the initial session helpful for building confidence in presentation delivery and recognizing the value of effective multimedia design, reporting increased awareness of the importance of multimedia quality in presentations. While confidence improved post-training, the pre-survey baseline of 3.5 out of 5 may represent initial overconfidence given residents’ lack of formal multimedia training, suggesting the intervention helped develop both realistic self-assessment and genuine competence. This positive reception and immediate value recognition suggest achievement of Level 1 goals (reaction) according to Kirkpatrick’s Four-Level Training Evaluation Model.

In assessing Level 2 goals, participants were better able to identify Mayer’s multimedia theories when assessed using pre- and post-intervention multiple-choice questions, though this improvement was not statistically significant. The longitudinal presentation assessment by an expert faculty member reinforced key theories through timely, actionable, goal-referenced, and specific feedback. Of note, for this study, only one site was selected for implementing formative feedback to ensure expert presence and reduce evaluator variability. Electronic surveys at the end of the four-month evaluation period suggested that residents found this formative assessment method useful and that it also achieved Level 1 goals on the Kirkpatrick scale.

Fewer words per slide on resident-developed teaching PowerPoint slides post-intervention than pre-intervention suggest the application of Mayer’s multimedia theories taught in the initial session, specifically the limited-capacity assumption and the coherence principle.

Word count per slide was chosen as an objective, though indirect, proxy for improved slide design, as previous research demonstrates that reduced text with predominant visual evidence leads to improved pre-to post-educational workshop test results in both short- and long-term retention analysis of professional students^8-10 Our intervention achieved a statistically significant reduction from 59.2 to 40 words per slide, approaching the recommended limit of 36 words per slide (goal: 6 words per line x 6 lines per slide).^11-13 This longitudinal evaluation of actual presentation behavior represents an assessment of Level 3 change (behavior) on Kirkpatrick’s Model. Figure 1 exemplifies a pre-intervention slide with an excessive word count (179 words) while Figure 2 demonstrates post-intervention improvement with a reduced word count (17 words). The post-intervention example illustrates the successful application of Mayer’s coherence principle, featuring reduced textual information, appropriate visual spacing, and flowchart formatting to minimize cognitive overload for audience members.

Figure 1.

Pre-intervention slide design: Illustrative example of excessive text

Figure 2.

Enhancing information delivery: Post-intervention slide example

This study has several important limitations. First, the study design, a single-group pre- and post-study, limits causal inference. Any observed improvements may be influenced by confounders such as resident maturation or concurrent training experiences (threats to internal validity). Second, the findings are based on a convenience sample, with only 34% of the residency cohort able to attend due to conflicting clinical responsibilities. This introduces a potential selection bias, as the participating group may differ systematically from the non-participants. This fact, combined with the single-institution design, notably limits the generalizability of our findings to other residents or institutions. Finally, our primary outcome measure, word count per slide, is a simplistic and indirect proxy for presentation quality. We acknowledge that this does not directly measure the desired behavior change in teaching effectiveness (Kirkpatrick Level 3) or its impact on learners.

Future research offers opportunities to build on these findings through improved study designs. Implementing structured attendance protocols would provide more comprehensive participation data and a broader representation of the resident population. Incorporating validated pre- and post-intervention assessment tools would enable precise measurement of teaching skill development and yield more robust outcome metrics. Employing targeted strategies to optimize response rates, such as protected time for evaluation completion or streamlined assessment processes, would strengthen data completeness and analytical power. Multi-institutional collaborative designs would expand the scope of findings and facilitate comparison across diverse training environments. Additionally, longitudinal studies featuring sequential workshop sessions could provide valuable insights into skill retention and progressive competency development. Qualitative methodologies that explore residents’ experiences and perceptions of how the training influenced their teaching practices would provide rich contextual data to complement quantitative outcomes and inform future curriculum refinement.

Our curriculum offers a novel model for a two-part educational intervention in longitudinal audio-visual presentation training and represents the first of its kind within post-graduate medical training. This investigation revealed that residents rarely receive formal training in the optimal use of multimedia platforms despite their frequent use in their teaching responsibilities. Following our educational workshop, residents demonstrated significantly increased importance and confidence ratings in their understanding of multimedia educational theories. Longitudinal formative evaluation of foundational didactic sessions yielded positive resident perceptions, while objective word-count analysis of resident-developed teaching slides for these sessions demonstrated a significant reduction in text post-intervention, indicating improved adherence to evidence-based presentation design principles. Achieving meaningful outcomes within one academic year demonstrates feasibility within the existing residency curriculum constraints. This study supports the integration of structured multimedia education into post-graduate medical training.

Conclusion

This study suggests the potential value of a structured multimedia education intervention for resident physicians, which was associated with improved presentation design practices and enhanced self-reported confidence in teaching abilities. The successful implementation and positive reception within a single academic year suggest that incorporating formal multimedia training could be a valuable component of post-graduate medical education curricula.

Supplemental Material

Supplemental Material - Outcomes of a Multimedia Educational Workshop in an Internal Medicine Residency

Supplemental Material for Outcomes of a Multimedia Educational Workshop in an Internal Medicine Residency by Sahana Venkatesh, Ronald Markert, Brian Elliott, Joseph Glendening and Kathryn M. Burtson in Journal of Medical Education and Curricular Development.

Supplemental Material

Supplemental Material - Outcomes of a Multimedia Educational Workshop in an Internal Medicine Residency

Supplemental Material for Outcomes of a Multimedia Educational Workshop in an Internal Medicine Residency by Sahana Venkatesh, Ronald Markert, Brian Elliott, Joseph Glendening and Kathryn M. Burtson in Journal of Medical Education and Curricular Development.