Open Access Research article

Blended learning approach improves teaching in a problem-based learning environment in orthopedics - a pilot study

David A Back127*, Nicole Haberstroh3, Andrea Antolic4, Kai Sostmann5, Gerhard Schmidmaier6 and Eike Hoff37

Author Affiliations

1 Department of Traumatology and Orthopedics, German Armed Forces Hospital Berlin, Scharnhorststrasse 13, 10115 Berlin, Germany

2 Dieter Scheffner Center for Medical Teaching and Educational Research, Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany

3 Center for Musculoskeletal Surgery, Department of Orthopedics, Charité – Universitätsmedizin Berlin, Berlin, Germany

4 Reformed Medical Track Program, Charité – Universitätsmedizin Berlin, Berlin, Germany

5 Dieter Scheffner Center for Medical Teaching and Educational Research, Charité – Universitätsmedizin Berlin, Berlin, Germany

6 Department for Orthopedics, Traumatology and Paraplegiology, University of Heidelberg, Heidelberg, Germany

7 Julius Wolff Institute and Berlin-Brandenburg Center for Regenerative Therapies, Charité – Universitätsmedizin Berlin, Berlin, Germany

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BMC Medical Education 2014, 14:17  doi:10.1186/1472-6920-14-17

Published: 27 January 2014



While e-learning is enjoying increasing popularity as adjunct in modern teaching, studies on this topic should shift from mere evaluation of students’ satisfaction towards assessing its benefits on enhancement of knowledge and skills. This pilot study aimed to detect the teaching effects of a blended learning program on students of orthopedics and traumatology in the context of a problem-based learning environment.


The project NESTOR (network for students in traumatology and orthopedics) was offered to students in a problem-based learning course. Participants completed written tests before and directly after the course, followed by a final written test and an objective structured clinical examination (OSCE) as well as an evaluation questionnaire at the end of the semester. Results were compared within the group of NESTOR users and non-users and between these two groups.


Participants (n = 53) rated their experiences very positively. An enhancement in knowledge was found directly after the course and at the final written test for both groups (p < 0.001). NESTOR users scored higher than non-users in the post-tests, while the OSCE revealed no differences between the groups.


This pilot study showed a positive effect of the blended learning approach on knowledge enhancement and satisfaction of participating students. However, it will be an aim for the future to further explore the chances of this approach and internet-based technologies for possibilities to improve also practical examination skills.

E-learning; Orthopedics; Traumatology; Problem-based learning; Blended learning