Evaluating student perceptions of image-based audience response questions in medical education

Audience response systems have been extensively utilized in medical and pharmacy education to improve learner engagement and knowledge retention. Unlike traditional ARSs that utilize text-based multiple-choice questions Hotspot is an image-based ARS integrated into PointSolutions that allows students to answer questions by selecting areas of interest on images and figures, rather than choosing from multiple-choice options. The purpose of this study was to evaluate student perceptions of integrating Hotspot into pharmacology and biomedical curricula, including perceived engagement, learning reinforcement, usability and preferences relative to traditional MCQs. Faculty at California Northstate University incorporated Hotspot questions into the lectures of first- and second-year courses across three matriculating classes. Following these sessions, students completed an anonymous survey. Survey items assessed student perceptions of engagement, perceived learning, and ease of use on a seven-point Likert scale. Learners reported that Hotspot technology made it easier to pay attention during lectures (median Likert score of six out of seven [interquartile range (IQR) 5-7]; n = 99). They felt the questions were a good use of class time (6 out of 7 [interquartile range 6-7]; n = 99) and indicated that the interactive format challenged them and reinforced their understanding better than MCQs (6 out of 7 [IQR 5-7]; n = 99). Overall, learners expressed a preference for Hotspot over traditional MCQs and reported that this approach was more engaging. These findings support the feasibility and learner acceptability of incorporating image-based active learning strategies and provide evidence to support the adoption of innovative instructional approaches in medical and pharmacology education.