The power of the pen: effectiveness of hand-drawn schematic diagrams In congenital heart disease ultrasound education for resident physicians : a randomized controlled trial.

Abstract

Background: Educating resident physicians to master the complex. Educating resident physicians to master the complex echocardiographic diagnosis of congenital heart disease (CHD) represents a substantial pedagogical challenge. The central difficulty lies in translating dynamic two-dimensional ultrasound images into a robust three-dimensional spatial understanding. While high-technology teaching aids have emerged, their significant cost and limited accessibility impede widespread adoption. This study was designed to rigorously evaluate the effectiveness of a low-cost, high-cognitive-engagement instructional method-instructor-led, real-time hand-drawn schematic diagrams-in augmenting the CHD ultrasound diagnostic capabilities of resident physicians.

Methods: A single-center, prospective randomized controlled trial was conducted. Forty residents rotating through the Department of Ultrasound at Zhangzhou Affiliated Hospital of Fujian Medical University from September 2024 to August 2025 were enrolled. Participants were randomly assigned to either an intervention group (n=20) or a control group (n=20). The control group received conventional PowerPoint-based instruction. The intervention group received the same conventional instruction supplemented with instructor-led dynamic hand-drawn schematic diagrams. The primary outcomes were objective assessment scores in ultrasonic theoretical knowledge, practical skill operation, and clinical reasoning abilities. Secondary outcomes encompassed subjective learning satisfaction and self- perceived understanding.

Results: All 40 participants successfully completed the study protocol. Theintervention group demonstrated significantly superior performance compared with the control group in theoretical knowledge (88.20 ± 3.96 vs. 82.95 ± 2.37, p < 0.001) and clinical reasoning abilities (90.50 ± 2.76 vs. 82.75 ± 3.60, p < 0.001). However, no statistically significant difference was observed in practical skills scores (89.40 ± 3.24 vs. 87.20 ± 4.99, p = 0.106). Subjective questionnaire surveys revealed that the intervention group provided significantly higher ratings across all assessed dimensions of learning and overall teaching satisfaction (all p < 0.05).

Conclusions: In the context of CHD ultrasound education for residents, theintegration of instructor-led hand-drawn schematic diagrams markedly enhances learners', theoretical knowledge and clinical reasoning. The limited direct impact on practical skills highlights the distinct developmental pathways for cognitive versus psychomotor competencies. These findings validate hand-drawn diagrams as an effective, economical, and readily implementable pedagogical tool, particularly well- suited for constructing the complex conceptual and spatial frameworks essential for mastering echocardiography.