An interdisciplinary team of experienced lecturers from the Department of Radiotherapy and Special Oncology and experts from the fields of didactics and digital teaching was formed to redesign the teaching. Student assistants were also involved in the implementation of the concept. On the basis of the ADDIE model [11], a concept for redesign was developed after the current teaching situation was analyzed, which formed the basis for developing the new courses. The ADDIE model describes a process for course development that is divided into five steps: analysis, design, development, implementation, and evaluation [12]. The different phases of the ADDIE model in the context of the redesign of the radiotherapy course are described below. Thereby, the first three phases are assigned to the methodological approach, while the implementation and evaluation are assigned to the results.

The first phase of the redesign entailed an analysis of the current situation, which included the identification of critical points and areas for improvement. It was essential to determine the exact amount of time previously dedicated to teaching and the content that was taught to establish the framework for the redesign. This phase also involved setting the main objectives for the revision. For instance, one objective could be that the amount of teaching time should remain unchanged for students.

Radiotherapy is taught at the MHH as part of the HannibaL model study program in the fourth year of study as part of the Radiology—Imaging Procedures, Radiation Treatment, Radiation Protection module. In one academic year, radiotherapy classes are held four times. Until the reorganization, teaching consisted of five 45-minute lectures and 2 hours of practical training in the Department of Radiotherapy and Special Oncology. It became increasingly apparent that student participation in the lectures was declining and that there was a growing desire for active forms of learning. For the new teaching concept, the time for knowledge transfer was therefore to be reduced to 135 min, which would correspond to three 45-minute lectures, in order to create time for an interactive seminar that would enable a more active form of learning.

To reduce the number of lectures without compromising the quality of knowledge transfer, all teaching content was critically evaluated, redundancies were identified, and the central teaching content was selected. In addition to the biological and technical basics, the radiotherapeutic treatment of selected clinical diagnoses (bronchial carcinomas, gastrointestinal tumors, central nervous system [CNS] tumors, prostate carcinoma, lymphomas) and urgent radiation indications should be taught. The tumor entities were selected according to their incidence in Germany [13] and the importance of radiotherapy in a multimodal treatment setting. The treatment of other tumor entities (such as gynecological or head and neck tumors) is covered in other modules. Information on side effects and late effects was designated as optional and supplementary learning material, as this mode focuses on teaching treatment concepts.

On the basis of the findings of the analysis and the definition of the goals, in the design phase, a new concept was developed and discussed with all lecturers. To enable flexible learning, the concept envisaged the implementation of all exam-relevant teaching content as online lecture recordings or as a multimedia learning module. As a practical introduction to the module, an educational film was also designed to convey the treatment steps in radiotherapy. The fundamentally new 2‑hour seminar was designed as a digital offers with flexibly retrievable (online) parts and scheduled parts on site. Case studies were created in preparation for the seminar, and clinical situations were constructed, which were prepared in advance by the students. As part of the seminar in the form of a video conference, these case studies were then discussed. The concept of the practical course within the clinic in small groups of up to 15 students now includes more practical aspects, such as creating a radiation mask.

The concept for reorganizing teaching thus provided for a combination of different didactic elements: theoretical knowledge transfer through a multimedia self-learning module, opportunities for synchronous communication processes to apply the knowledge in the form of a seminar, and the acquisition of practical experience in everyday clinical practice through visits to the clinic (Fig. 1).

Components of the blended learning concept for the redesign of the radiotherapy course for medical students, enabling a different way of learning for acquiring the content and achieving the learning objectives

An example of the learning objective “Understanding the importance of radiation preparation and planning” can be found in the module as follows: Online, students are guided through the workflow and learn, for example, the indications for an irradiation mask and how it is made in practice, using text, graphics, and videos. This is then linked to corresponding clinical pictures, which are taken up again in the case studies of the seminars and discussed together. Finally, an irradiation mask is physically made with the students in the block internship in the appropriate sequence as part of the overall treatment process. The concept for the redesign, which envisaged an hour-neutral restructuring of curricular teaching for students, was submitted to the study commission and approved.

In the development phase, all necessary learning materials were created, and the evaluation was designed. To create the learning materials, filming was carried out on the premises of the Department of Radiotherapy and Special Oncology in September and October 2023. To avoid disrupting the clinic’s routine, filming took place outside of the usual treatment times. Various scenes were filmed in different rooms of the clinic and then edited to create a chronological sequence of the radiotherapy treatment of a fictitious patient. Doctors and a Medical Technologist in Radiology (MTR) from the clinic played the protagonists in the film, with one doctor assuming the role of the patient. The off-screen commentary by a doctor explains a typical treatment procedure and the specific radiotherapy measures shown in the film. In the film, two doctors, as role models, guide the students through various stages of treatment: the film begins with the first sequence, in which the two doctors walk towards the camera in the reception area of the clinic and speak directly into the camera and, thereby, to the students. In further scenes, the doctors show and explain the individual steps of the treatment to the students, from the initial consultation, to planning of the radiotherapy and preparation of a radiotherapy mask, to radiotherapy of the patient. The presentation of the patient at an interdisciplinary tumor conference is also discussed. The students are given cinematic insight into various work processes and treatment rooms. The planning of computer tomography on the PC, the preparation of the radiation mask by the MTR for positioning the patient during radiation, the implementation of the therapy with the linear accelerator, and the debriefing with the patient are shown. The film ends with short statements by the doctors from the radiotherapy clinic. They formulate their individual views of everyday clinical work in radiotherapy and interaction with patients. The personal perspectives convey the special appeal of the subject.

Apart from this educational film, schemes for various treatment pathways have been created for clinical diagnosis and urgent radiation indications. The schemes are based on the clinic’s standard operation procedures (SOPs) for the respective clinical pictures, which are based on guidelines. Using these schemes, students can understand the respective radiation indications depending on tumor histology and spread diagnostics and independently develop treatment paths for patients. Thus, the role of radiotherapy can be illustrated particularly well in the context of multimodal treatment concepts. For each clinical picture, lectures of 10 to 15 min in length were recorded via schemes in which the doctors explained the most important steps and treatments in radiotherapy.

Short explanatory texts were written on typical side effects and late effects. Additionally, central care and treatment as well as integrative recommendations were made.

Furthermore, multimedia learning modules with texts, images, and videos were created for the biological and technical basics.

For the seminar, three case studies with typical clinical findings were prepared. All three cases describe critical situations, two of which are emergencies at the weekend. Questions concerning the suspected diagnosis, differential diagnosis, further procedures, and therapeutic options were developed for each case example. The case studies and associated questions were implemented as digital surveys in the MHH learning management system, so that the results of the survey can build the basis for discussion in the seminar. In the survey on the basis of various questions, the students are asked to make diagnostic and therapeutic decisions. The students do not receive immediate feedback on their decisions. Instead, all the student data are stored by the learning management system, automatically evaluated statically, and presented in diagrams. Teachers can view the results of the survey before the seminar begins and obtain a clear impression of the students’ assessments. In the subsequent online seminar, the students’ decisions regarding the cases are then presented by the lecturers, and the critical aspects are discussed with the students. Since all the students have already dealt with the cases in advance, their active participation in the seminar is supported.

All the digital parts were made available in the MHH learning management system. The entry page to the module was designed according to a scheme developed together with student assistants as part of the Lower Saxony joint project SOUVER@N—Sovereign Digital Teaching and Learning in Lower SaxonyFootnote 1.

Once the learning materials had been completed, a workshop was held before the start of the academic year with the four doctors conducting the seminars to introduce them to the didactic concept for conducting the seminars. The case studies were presented to the doctors in the workshop, and the seminar procedure was discussed with them. To ensure the uniform design of the seminars, the lecturers were asked to view the survey results concerning the three case studies before the synchronous case discussion began and to respond to the students’ selected answers in the seminar. The teachers also received a presentation with individual case studies.

A questionnaire with 17 items related to various aspects was designed for the evaluation. The questionnaire recorded assessments of the requirement profile of the module, the design of the digital learning materials, and the possibility of acquiring skills through the learning materials. The evaluations of the seminar and the internship were also surveyed. There were also questions on the overall assessment and skills acquisition. It was also possible to make free-text comments. With respect to the students’ learning behavior, they were also asked whether they had worked on the digital learning content before the internship (Table 1).

The evaluation was carried out by the MHH evaluation office. At the end of each seminar, the lecturers informed the students of the opportunity to participate in the evaluation. The link to the survey was accessed via the learning platform. However, the evaluation results of the survey were recorded on a different platform. Teachers and those involved in the digital implementation did not have access to this platform. The evaluation of the modules was voluntary, anonymous, and not incentivized. After each implementation, the teaching staff and those involved in the digital implementation received the respective evaluation results. This should make it possible to react to any problems.

The feedback and usage figures for all four runs of the 2023/24 academic year were evaluated for this publication. Statistics and figures were generated using Microsoft Excel 2021 (Redmond, WA, USA). The analysis uses descriptive statistical methods to calculate the frequency distribution, median (mdn), and interquartile range (IQR) for all the closed questions. For the items with a six-point scale, the frequencies of the scales 1 to 3 were clustered as positive evaluations, and the frequencies of the scales 4 to 6 were summarized as critical attitudes. The answers to the open questions were summarized and evaluated by the last author. The access data from the learning management system were used to evaluate the usage figures.