Thomas the Tank Engine significantly improves the understanding of oxygen delivery and hypoxaemia

Dear Sir

Physiological concepts are often poorly understood with students ‘knowing’ but not ‘understanding’ (Berlucchi & Di Benedetta 2000). Therefore with respect to oxygen delivery and hypoxaemia we have used images of Thomas the Tank Engine delivering coal to improve comprehension (Cosgrove et al. 2006). To evaluate the process we presented two 30-minute lectures to Year One Medical Students. The control lecture was a conventional presentation; the study lecture contained additional images of Thomas the Tank Engine. LREC approval was unnecessary; HiT Entertainment-UK granted permission to use the imagery. Students were randomised into four groups (A n = 73, B n = 56, C n = 59, D n = 53). Groups A and B received the control lecture, while C and D the study lecture. Groups A and C undertook a pre-lecture MCQ to assess background knowledge. All students completed a post-lecture MCQ and qualitative evaluation of the lecture. Evaluation scores (out of 20 for the MCQs) were collected using an ARS-KEEpad system and compared using the Mann–Whitney U-test. A p-value ≤ 0.05 was regarded as significant.

The post-lecture MCQ scores failed to demonstrate any evidence of gender stereotyping or priming (A vs. B, p = 0.6 and C vs. D, p = 0.4.) Both lectures significantly improved post-lecture MCQ scores (p < 0.001.) Group A had a significantly higher pre-lecture MCQ score compared to group C (median 16 vs. 12, p < 0.001); there was no difference post-lecture between A and C (median 18 vs. 17, p = 0.4). Qualitatively the imagery also made the lecture significantly more organised (p = 0.006), interesting and stimulating (p < 0.001) and improved understanding (p < 0.001.) At 6 months there was no significant difference in MCQ scores (p = 0.4). Groups A and B had the same median MCQ score at 6 months as group A pre-lecture MCQ (p = 0.9). Groups C and D had a significantly higher median MCQ score at 6 months compared to group-C pre-lecture (p < 0.001).

In conclusion, analogous imagery significantly improved aspects of understanding hypoxaemia and in students with lower levels of background knowledge, the imagery allowed them to attain knowledge levels similar to their peers and minimised knowledge decline-ratio at 6 months. Thus compared to a didactic lecture, imagery of Thomas the Tank Engine delivering coal can provide an improved structure for lecture delivery and knowledge retention, assisting medical students in engagement with learning and understanding the processes of oxygen delivery and hypoxaemia. The improvement in scores post-lecture can also assist the lecturers (both registered with the General Medical Council) in their revalidation process.