How to design effective educational videos for teaching evidence-based medicine to undergraduate learners – systematic review with complementing qualitative research to develop a practicable guide

Figures & data

Figure 1. “Spiral model” – Process model for adapting the requirement analysis to subsequent interviews.

Figure 2. Grounded theory approach incorporating different standards of reporting.

Figure 3. Graphical summary according to the PRISMA guidelines.

Table 1. Literature-based requirement analysis for eLearning content and educational videos – User stories.

Keyword/Topic	As a …	I want …	so that …	Example/Advice/Note	Reference(s)	Approved by interviews
Dual channel/Manage processing/Synchronizing/Matching	student	to get videos	I can follow the content as well visually as auditorily and build connections between audio and video		Mayer [10] Mayer & Moreno [22] Brame [24]	++
Continuous input flow	student	animations, which are building up, to be in the videos	I get a continuous input flow	You may also consider the ‘Khan style’.	Mayer [10] Mayer & Moreno [22] Guo et al. [9]	++
Khan style	creator	to use the Khan style (hand-written step-by-step explanation with voice commentary)	the students are more engaged due to the equal levels of the student and teacher	CAVE: controversial!	Guo et al. [9] Cross et al. [49]	0/+
Good visuals	student	to see well-made visuals	I can learn more effectively with them	Try to create clean and timeless visuals.	Norman [26] Iorio-Morin et al. [28] Choe et al. [30]	(++)
Reduce extraneous processing	student	the videos to be ‘clean,’ without distracting material	I concentrate on the learning objectives	no background music, etc.; controversial, especially in teaching procedures without additional text	Mayer [10] Wong [50]	++
− Weeding	creator	to plan for the format	the video does not contain unnecessary information and can be produced faster	CAVE: unnecessary vs. interesting and vivid detail → see Personalization	Guo et al. [9] Overbaugh [21] Brame [24] Norman [26]
− Avoid Redundancy	student	to see content presented with animations and not see the spoken text	I am focused on the subject matter and do not read what I am hearing		Mayer [10]
− Signaling	student	to be taken to the very important points	I can focus on them	Highlight the main points.	Mayer [10] Brame [24]
− Temporal continuity	student	to see the animation/keyword while it is verbally explained	I can process the content simultaneously on both channels	Present visual and audio content at the same time.	Mayer [10]
− Spatial continuity	student	to see corresponding text and animation near each other	I can focus on one part of the screen	Present corresponding material in synchrony.	Mayer [10]
Manage essential processing/Learner control − Segmenting	student	to work with structured/divided videos	I learn from short chapters that I can process	Use checkpoints after short parts of your video, which must be clicked on.	Mayer [10] Overbaugh [21]	++
− Use of chapters	student	to get videos using chapters	I can navigate directly to the relevant chapters I want to repeat		Roshier et al. [14] Brame [24]	++
− Limit video length	student	to get short (roughly six-minute-long) videos	I watch the video up to its end	Mind the length while scripting; longer videos may be useful, too.	Guo et al. [9] Dong & Goh [25] Young et al. [29]	0/+
– Pre-training	student	to get taught/an introduction prior to a video curriculum	I can follow more easily (e.g., because I know the technical terms)		Mayer [10] Overbaugh [21]
Personalization	student	to be addressed in a conversational style and/or informal setting	I can build a social partnership and try harder to understand the topic	Narrate the lesson from your perspective. Show your interest in the topic. You may consider the inclusion of interesting details that are not directly linked to the learning goals.	Guo et al. [9] Mayer [10] Brame [24] Overbaugh [21] Maloy et al. [51]
− Optimizing the voiceover	student	the narration to have simple syntax	I can follow the speaker easily and effectively	Do not worry about an excessively simple script.	Iorio-Morin et al. [28]
− Speed	student	to get videos in the appropriate speed	I can follow easily and effectively	Suggestions: ≥ 160 words per minute (wpm) [9]; 185–254 wpm [24]	Guo et al. [9] Brame [24]	++
− Target group	creator	to match the content for the target group	the students are more engaged	How can you show the students that it is content for them; you may contextualize your videos.	Brame [24] Fleming [46]
− Pattern	creator	to develop and use a recognition pattern (at the beginning of each video)	the videos become more structured	Think of structuring your content, and develop a welcome pattern.	Norman [26]
− Humor	student	to see humorous videos	I learn better and am more motivated	Be wary of excessive humor but consider light humor to break the ice.	Iorio-Morin et al. [28]	0/+
− Talking head	student	to see the speaker’s face at least occasionally	I am more engaged although it might be more distracting	CAVE: controversial!	Guo et al. [9] Dong & Goh [25]	0/+
Guiding question	student	to get focused on the relevant topics through guiding questions	my interest becomes aroused, I know what the lesson’s goal is and am less distracted	Think of practical, interesting, or provocative questions to start your lesson.	Overbaugh [21] Brame [24] Norman [26]
Active Learning/Questions/Repeated testing	student	to be asked questions on the topics repeatedly during or after the videos	I internalize the messages of the videos		Spreckelsen & Juenger [52] Brame [24] Overbaugh [21]	++
Games	student	to be able to participate in a quiz with my course mates or to play games concerning the learning content	I am more engaged and learn while playing	Quizzes can be implemented easily if you have a pool of MC questions.	McCoy et al. [53]	0/+
Modularity	creator	to create modular videos	I can adapt these to other contexts	Think about possible fields of use before creating content.	Norman [26]
	creator	to create self-contained learning entities	I can use them in different courses and over a long time	Avoid links, etc., to outside resources in your videos; do not number videos so that you can combine them in new ways.	Norman [26]
Context	creator	to embed the videos in the (medical) context	the students are more motivated learners because they imagine the topics applied in context	Tell your students why they should learn the content.	Overbaugh [21] Brame [24]	(++)
Examples	student	to be confronted with relevant (medical) examples and examples that I understand intuitively (e.g., examples from everyday life)	I am more enthusiastic concerning the learning content	Think about your students’ knowledge and choose examples from prior courses; deliver an additional point of view to support understanding; think about relevant stories and narrations.	Overbaugh [21] Malloy et al. [51] Adam et al. [54]	++
Appropriate content	creator	to choose appropriate content	content is delivered that benefits from the ‘video’ presentation mode	Concepts can be delivered well via videos.	Rana et al. [27] Iorio-Morin et al. [28]
Take-home messages	student	the videos to end with take-home messages	I can remember the relevant points better		Phelan [55]	++
Usability	student	to use an eLearning platform that simply works and is visually appealing	I can concentrate on the learning content and am engaged in using this learning modality		Roshier et al. [14]	++
– Mobile use/Screen management	student	the videos on a platform that is enabled for mobile use/the screen content is well managed	I can learn on any device I want at any place	Make your videos enjoyable on small screens (e.g., 4.7”).	Jang & Kim [56] Choe et al. [30]	++
− File format	student	to use the videos on any device ‘out of the box’	I do not face barriers to using the videos	Use common formats that most operating systems support (e.g., mp4/HTML5).	Dong & Goh [25]
− Availability	student	to get access to the contents early	I can prepare my course any time I want	The content should ideally be completely produced before the course starts.	Margolis et al. [57]	(++)
Planning in advance	creator	to plan the videos	I can produce high-quality video content and identify suboptimal shoots		Guo et al. [9] Iorio-Morin et al. [28]
− Scripting	creator	to script out the video	I can produce the video more effectively, and I can easily create subtitles		Norman [26]
	creator	to script out the video	I can create a summary for the students		Norman [26]
Administrative − Monitoring	teacher	to be able to monitor the use of the eLearning content	I can remind tardy students; I can identify topics that may still be challenging	CAVE: Depending on your institution’s eLearning privacy policy, metadata may not always be available by default.	Rana et al. [27]
	creator	to be able to monitor the use of the eLearning content	I can evaluate how videos were used to identify attributes that are associated with viewing characteristics	Metadata could be a valuable indicator of the acceptance of, say, design implementations.	Rana et al. [27]
	scientist	to be able to monitor the use and test results of the eLearning content	I can evaluate the learning outcomes aligned with using characteristics	CAVE: Be aware of data protection laws while planning your studies.
– Legal & Licenses	creator	to use only content that I am allowed to use	I can provide the videos	Try to create content on your own as much as possible so that you hold all rights to it.	Roshier et al. [14]
− Evaluation and Review	creator	my videos to be reviewed and evaluated in a preplanned manner	I can provide even better content	Establish review structures and procedures; plan an evaluation survey at the end of the course and provide a feedback e-mail address.	Roshier et al. [14] Young et al. [29] Authement & Dormire [47] Yavner et al. [58]

Notes. ++: interviews support statement strongly; 0/+: results of interviews were not consistent, but a tendency could be found; (++): content of the interviews supports statement indirectly/implicitly; a shaded row means the category was defined deductively.

Table 2. Results of analysis of semi-structured interviews at RWTH Aachen University in 2018 (n = 11).

Keyword/ Topic	Leading quotation(s)	Number of supporting statements	Conclusion	Comments/ Additional information
Testing	‘You did something actively and did not just read things through, so you were constantly required to perform and I think you then simply learned better’ [ID01].	9 supporting 1 neutral 0 contradicting	Implement testing.	interviewees’ requests: − no excessive workload − not too redundant − appropriate difficulty (not too easy) − provide solutions
Khan style	‘It’s not bad to see things written’ [ID02].	6 supporting 1 ambivalent 1 contradicting	Implement subsequent animations/ writing if possible, and check traditional Khan style for suitability in individual cases.	Note: The content of the interviews changed from traditional handwritten Khan style to subsequent animations.
Animations	‘It’s cool for schematics if they build up one after the other’ [ID03].	5 supporting 0 contradicting	Implement subsequent animations if possible.
Usability	‘[It’s important] that it works logically and simply somehow. The easier, the better’ [ID03].	7 supporting 0 contradicting	Try to use a simple and intuitive eLearning environment.	Depending on which software is used at your institution for students’ eLearning, you may use this familiar software.
Mobile use	‘[…] especially when it’s also possible on my mobile phone’ [ID01].	7 supporting 0 contradicting	Make the videos available on mobile devices.
Structuring	‘Do I find that under “human medicine,” under “lecture,” under “media library,” or under “no idea”?’ [ID03]. ‘I rarely use [our institution’s media library] because it’s too confusing’ [ID02]. ‘The titles have to be well chosen so that they are concise and describe the content’ [ID04].	3 supporting 0 contradicting	Give your eLearning environment a good structure.	You may also tag your videos/content and implement a search function.
Chapters	‘[I’d appreciate] it if the videos were broken down to sub-items so that you would only have to look at the sections you wanted to see’ [ID05].	6 supporting 0 contradicting	Implement chapters.
Length	‘The maximum would be about 15 minutes because, beyond then, I would no longer be attentive. Five minutes is already a good length, but the videos must not be shorter. Something between 5 and 15 minutes’ [ID05]. ‘Using chapters, the length is not so important anymore’ [ID06].	8 supporting 0 contradicting	Try to create short videos, but do not worry if you exceed the six-minute limit slightly.
Speed	‘Not too fast and not too slowly’ [ID06].	4 supporting 0 contradicting	Extract ideal speed from literature.	Note: Speed was considered an important success factor for educational videos.
Take-home messages	‘I think that’s actually quite good because you learn the beginning and the end well’ [ID06].	5 supporting 0 contradicting	Formulate take-home messages.
Reduce extraneous processing	‘There was so much background information – that was too much of a good thing’ [ID07].	6 supporting 0 contradicting	Avoid too much background information; reduce distractions (content-wise & artistically).	Note: Nevertheless, the topic should be covered completely.
Talking head	‘I’d find that more personal’ [ID08]. ‘I don’t care to see the speaker – it can be good, but it doesn’t have to be’ [ID02]. ‘I’m not a fan of [educational] videos in which you see the speaker. I don’t like that at all’ [ID01].	2 supporting 3 supporting 0 supporting	Check the talking head for suitability in individual cases. Ensure that the talking head does not interfere with the display of other elements.	You may consider both weaning on the one hand and more engagement and personalized videos on the other. Note: Many participants expressed concern about the space needed on the screen.
Medical examples vs. everyday-life examples	‘[I’d appreciate] both; first, I would look at everyday life and then at what helps me later in my job’ [ID04]. ‘I thought it was good that they were medical tests. […] But it should already be realistic’ [ID09]. ‘I actually always prefer everyday examples’ [ID08].	7 supporting 0 supporting 1 supporting	Try to implement both types of examples and aim for realistic ones.
Humor	‘It mustn’t be forced. Discreetly funny but not too forced’ [ID04]. ‘In longer videos, it helps in any case, and, even in short videos, it does no harm. But as for whether it is necessary … [?]’ [ID10]. ‘I don’t really care. It must be interesting … but it doesn’t have to be done through humor … then better serious’ [ID03].	3 supporting 1 supporting 1 supporting	Design your videos to be appealing and use discreet humor.	Note: Spontaneous and self-ironic humor was designated an appropriate and pleasant form of humor.
Games (Quiz)	‘I am a very playful person, I’d like that’ [ID06]. ‘Yeah, you could do that, but you don’t need to’ [ID09]. ‘I find comparison with other students difficult’ [ID03].	7 supporting 1 supporting 0 supporting	Implement a quiz or games, if possible, consider offering the games as a voluntary option.	Ideally, the quizzes should run on mobile devices, too.
Videos as additional learning modality	‘It’s good to learn with such an additional offering [videos]. It is simply another way of learning’ [ID08].	5 supporting	Videos seem to be accepted as a learning tool.

Note. Shaded rows mean that the category was defined deductively.

Table 3. Our checklist for educational videos for video-based eLearning.

	Fulfillment? *
Does the content benefit from the “video” presentation mode (e.g., for teaching concepts)?	0 1 2 3
Context
Is the content embedded in a larger context?	0 1 2 3
Are tangible examples (ideally chosen from everyday life and from specific [medical] situations) used to illustrate the content?	0 1 2 3
Dual channel
Does the video provide audio and visuals that align with each other (“synchronizing/matching”)?	0 1 2 3
Does the video provide a continuous input flow (e.g., animations building up, Khan style)?	0 1 2 3
Are the visuals well-made and specifically appropriate for video use?	0 1 2 3
Reduce extraneous processing	0 1 2 3
Is the video clean and lacking in distracting elements (e.g., background music)?	0 1 2 3
Is unnecessary information absent from the video (“weeding”)?	0 1 2 3
Is redundancy avoided in the audio and visuals (e.g., the same text is not presented in spoken form and in an on-screen textbox)?	0 1 2 3
Are very important points highlighted (“signaling”)?	0 1 2 3
Are corresponding audio and visuals presented at the same time (“temporal continuity”)?	0 1 2 3
Are corresponding visuals presented near each other (“spatial continuity”)?	0 1 2 3
Manage essential processing
Is the video length limited to about six minutes, or does it not exceed 10 minutes when the content cannot be presented didactically flawlessly in only six minutes?	0 1 2 3
Is the video divided into short chapters (“segmenting”)?	0 1 2 3
Does the video stop automatically after each chapter?	0 1 2 3
Does the audience have at least limited previous knowledge of the topic?	0 1 2 3
If not, is pre-training provided?	0 1 2 3
Personalization
Is the audience addressed in a conversational style and/or an informal setting?	0 1 2 3
Does the narration feature simple syntax?	0 1 2 3
Is the speed appropriate (≥ 160 words per minute)?	0 1 2 3
Is the audience addressed directly so that it is clear that the video was made for its members?	0 1 2 3
Does a coherent structure exist throughout all videos (e.g., recognition patterns)?	0 1 2 3
Do take-home messages summarize the content at the end of the video?	0 1 2 3
Does the video include (light and self-deprecating) humor to an appropriate degree?	0 1 2 3
Active learning
Does the video include guiding questions?	0 1 2 3
Are there questions and tests concerning the video to use during or after watching?	0 1 2 3
Is a player-vs.-player quiz implemented?	0 1 2 3
Usability
Is the eLearning platform easy to use, structured, and visually appealing?	0 1 2 3
Is there an alternative presentation modality for users with visual disabilities (e.g., audio only)?	0 1 2 3
Are the users familiar with the platform?	0 1 2 3
Is the video tagged with keywords?	0 1 2 3
Is the platform enabled for mobile use?	0 1 2 3
Can the eLearning program be used “out-of-the-box” on any device?	0 1 2 3
Is the content available early so that users can prepare for the course when they have the time?	0 1 2 3
Planning in advance
Is there a script for every video planned?	0 1 2 3
Is there a written summary for the users?	0 1 2 3
Is the video reusable, and does it exclude references to resources that you do not control (e.g., links)?	0 1 2 3
Is the video modular so that it is unnecessary to recreate it completely if anything changes?	0 1 2 3
Administration
Does the platform allow monitoring to evaluate the use of the content?	0 1 2 3
Have all laws (e.g., copyright and data protection) been observed?	0 1 2 3
Has the video been reviewed and evaluated by a peer?	0 1 2 3

*Degree of fulfillment: not at all fulfilled (0), slightly fulfilled (1), moderately fulfilled (2), completely fulfilled (3).

Box 1 Search strings used for the initial literature search

((((video OR educational video OR video-based eLearning OR video based learning OR video eLearning OR video learning OR medical video OR video tape recording[MeSH]) AND (online)) AND (medical students[MeSH] OR students[MeSH])) AND (educational technology[MeSH])) AND (guidelines as topic[MeSH])

(((video OR educational video OR video-based eLearning OR video based learning OR video eLearning OR video learning OR medical video) AND online) AND ((medical students[MeSH] OR students[MeSH]) AND ((educational technology[MeSH]) AND education) NOT game) NOT flipped classroom)

education AND checklist AND online AND (students OR undergraduate)

multimedia guidelines AND education

eLearning design

humor AND video AND education

video based learning

video eLearning

video learning

Table

Category name	Nominal/Ordinal	Values	Definition/Basic encoding rules	Anchor Example	Further encoding rules/Depth
Experiences concerning video-based learning	Nominal	–	This category must be coded if the interviewee mentions any experience concerning video-based learning, including best-case and worst-case experiences.	‘And that’s when I really went under the covers because that was just badly presented and I just stopped after two videos because I just got the crisis. But if videos are well prepared and presented in a summarizing way, I think it would make a lot of sense.’	–
Experiences concerning text-based learning	Nominal	–	This category must be coded if the interviewee mentions any experience concerning text-based learning, including best-case and worst-case experiences.	‘Sometimes I find it more pleasant to have a text, because you can jump back and forth at your own pace.’	–
Khan style	Ordinal	C1 endorses Khan style C2 ambivalent about Khan style C3 opposes Khan style	This category must be coded if the interview content deals with Khan style in the sense of implementing step-by-step written explanations/development of content OR in the sense of subsequent text animations.	‘Take notes on a tablet and the integrate that in eLearning. Yes, that’s it.’	Respect all commentaries and opinions on Khan style. Code every reaction after the interviewer’s question about Khan style.
Animations	Ordinal	C1 endorses subsequent animations C2 ambivalent about subsequent animations C3 opposes subsequent animations	This category must be coded if the interviewee mentions aspects concerning subsequent animations.	‘It’s cool for schematics if they build up one after the other’	Respect all commentaries and opinions on animations. Code every reaction after the interviewer’s question about animations.
Medical examples vs. everyday-life examples	Ordinal	C1 endorses medical examples C2 ambivalent about medical or everyday-life examples C3 endorses everyday-life examples	This category must be coded if the interviewee mentions his/her opinion on examples in education OR mentions aspects concerning this topic.	‘[I’d appreciate] both; first, I would look at everyday life and then at what helps me later in my job’	Respect all commentaries and opinions on examples. Code every reaction after the interviewer’s question about examples.
Testing	Ordinal	C1 endorses repeated self-testing C2 ambivalent about repeated self-testing C3 opposes repeated self-testing	This category must be coded if the interviewee mentions his/her opinion on self-testing OR mentions aspects concerning this topic.	‘Well, I have to say that for me personally, I always perceived that [self-tests were] very helpful. You had the question, could immediately think about it, and then got the feedback directly.’	Respect all commentaries and opinions on self-testing OR testing in eLearning. Code every reaction after the interviewer’s question about examples.
Games (Quiz)	Ordinal	C1 endorses games in eLearning C2 ambivalent about games in eLearning C3 opposes games in eLearning	This category must be coded if the interviewee mentions his/her opinion on games in eLearning in general OR mentions aspects regarding player-vs.-player quizzes.	‘That might be a pretty good solution to make it a little more playful and less static. It might not be the way to teach it completely, but I can imagine it as a good start or for recapitulation.’	Respect all commentaries and opinions on games and quizzes OR games in eLearning. Code every reaction after the interviewer’s question about games.
Usability	Nominal	–	This category must be coded if the interviewee mentions anything on usability in eLearning.	‘I would appreciate one to have the system under control so that it doesn’t crash all the time.’	Respect all commentaries and opinions on (perceived) usability in eLearning, including but not limited to best-case and worst-case examples.
Video length	Nominal	–	This category must be coded if the interviewee mentions anything on preferred or opposed length of educative videos.	‘The maximum would be about 15 minutes because, beyond then, I would no longer be attentive. Five minutes is already a good length, but the videos must not be shorter. Something between 5 and 15 minutes.’	Respect all commentaries and opinions on the duration of education videos, including but not limited to best-case and worst-case examples and conditions that might affect the opinions.
Talking Head	Ordinal	C1 endorses ‘talking head’ in videos C2 ambivalent about ‘talking head’ in videos C3 opposes ‘talking head’ in videos	This category must be coded if the interviewee mentions anything about the lecturer’s/creator’s on-screen presence in educational video and his/her perception of this.	‘I don’t care to see the speaker – it can be good, but it doesn’t have to be’	Respect all commentaries and opinions on a ‘talking head’ in educational videos and conditions that might affect the opinions.

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