A collection of powerful diagnostic tools have been developed under the umbrellas of NATO for ionizing radiation dose assessment (BAT, WinFRAT) and estimate of acute health effects in humans (WinFRAT, H-Module). We assembled a database of 191 ARS cases using the Medical Treatment Protocols for Radiation Accident Victims (METREPOL, n=167) and the System for Evaluation and Archiving of Radiation accidents based on Case Histories (SEARCH, n=24) for training purposes of medical personnel. From 2016-2019 we trained 39 participants comprising MSc level radiobiology students in an on-site teaching class. Enforced by the covid-19 pandemic in 2020 for the first time, an online teaching of nine MSc radiobiology students replaced the on-site teaching. We found that: (1) limitations of correct diagnostic decision-making based on clinical signs and symptoms were experienced unrelated to the teaching format. (2) A significant performance decrease concerning online (first number in parenthesis) versus on-site teaching (reference and second number in parenthesis) was seen regarding the estimate time (31 vs 61 cases per hour, 2-fold decrease, p=0.005). Also, the accurate assessment of response categories (89.9% vs 96.9%, p=0.001), ARS (92.4% vs 96.7%, p=0.002) and hospitalization (93.5% vs 97.0%, p=0.002) decreased by around 3-7%. The performances of the online attendees were mainly distributed within the lower quartile performance of on-site participants and the 25-75% interquartile range increased 3-7-fold. (3) Comparison of dose estimates performed by training participants with HARS severity mirrored the known limitations of dose alone as a surrogate parameter for HARS severity at doses less than 1.5 Gy, but demonstrated correct determination of HARS 2-4 and support for clinical decision making at dose estimates > 1.5 Gy, regardless of teaching format. (4) Overall, one-third of the online participants showed substantial misapprehension and insecurities of elementary course content that did not occur after the on-site teaching.
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