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E-learning, in its broadest sense, is the use of networked information technologies in education. E-learning is also called as web based learning, online learning or Internet based learning. E-learning is not bound to time and classroom attendance - students and teachers may be at different locations on different times. One of the most common types of E-learning takes the form of distance learning courses. Universities upload course material for the student to study individually and complete tasks based on the course material. This allows students to access the course material on the web anytime and from anywhere. Advancement in computing and information technology coupled with almost universal availability of the broadband make e-learning an enticing option in many fields including medical education. In this assignment I will be reflecting on my personal experience with e-learning. I will also discuss its applicability in undergraduate medical education, postgraduate medical education and continuing medical education of practicing clinicians.
Theory behind e-learning
The meaning of knowledge and learning have changed through time. There is a certain swift in emphasis on learning, rather than teaching, as we rightly move towards a learner centred curriculum. E-learning, which is based on well documented adult learning principles, certainly facilitates a learner centred approach. Traditional education is based on instructivism theory. Teacher or tutor teaches a predefined set of information, deciding what students had to learn. Students learn to pass the examination. E-learning is based on constructivist and cognitive theories suggesting that learning is individualised and the student's past experiences and knowledge have a great impact on the newly acquired knowledge (Jonassen 1994). Blended learning refers to learning involving multiple methods and approaches, commonly a mixture of class room and e-learning
Requirements for successful implementation
Mitchell and Honore 2008 proposed a pyramidal system for successful implementation of e-learning programmes. The base of the pyramid, which forms the foundation for successful e-learning programme, consists of appropriate, accessible technology and usable, stimulating and interactive design. The apex of the pyramid is represented by the individuals who are involved in the programme and their attitude and motivation forms a major part in the success of e-learning methods. Basic computing skills are essential for the success of e-learning. There is an assumption that the current undergraduates have the necessary computing skills. Kiran et al 2004 has shown that computing skills among undergraduates are variable and one can not assume expertise or even ability. Good technical support is essential including 'after hours' support. For effective e-learning, student should be able to access material quickly both on campus and at home. Slow connectivity can be a problem. There is considerable cost involved in setting an e-learning programme.
Role of e-learning in Continuing Medical Education
All practicing clinicians in the United Kingdom are obliged to attend Continuing Medical Education programmes to maintain knowledge and skills as a part of appraisal and revalidation (The General Medical Council). E-learning offers excellent opportunities in this area. I have completed many online e-learning courses. Advantages of these courses include minimal cost, no travel cost and there is no need to take time off to attend these courses as they can be completed from home. They offer excellent value for money and the quality of these courses are comparable to that off traditional courses.
I recently attended an advanced laparoscopic surgery skills course. Few weeks prior to the course I was asked to sign up to the course organiser's web site. I was able access part of the course material. This enabled me to practise some of the skills prior to attending the course. This has certainly enhanced my learning more than I would have acquired without the access to the e-learning material. There were 20 participants form 8 countries and most found the e-learning very useful.
E-learning has made it possible for practicing clinicians from a remote part of the world to contact their peers through video conferencing in the management of difficult clinical situations and this facilitates on-the-job learning. When I was a resident in 1989 I had to wait for over two weeks to find out about an important adverse effect of a drug which now I could find out in a couple of minutes using online electronic databases. In medical education there can be no doubt that opportunities for learning occur all the time and not confined to the class room and e-learning has a lot to offer in this regard.
Role of e-learning in Postgraduate Medical Education
E-learning plays an important role in Postgraduate Medical Education. Many Deaneries across the United Kingdom has setup e-learning portals for the benefit of postgraduate trainees. Harden 2006 suggested that e-learning will be one of the most important developments in the delivery of postgraduate medical education. In surgical training many hands on courses utilise e-learning methods to enhance face-to-face learning.
Types of e-learning resources
The basic e-learning resources include e-textbooks, power point presentations of lectures and electronic notice boards. The communication in these methods is one way. Bilham 2005 argues that much of e-learning using these methods was based upon a model of knowledge transmission from the teacher to student as in the traditional education system. The rise of new technologies has turned the World Wide Web from strictly an information destination into a platform, not only to read or watch media, but to actually do things (Martin and Parker 2008). This has made innovative approaches possible in the field of medical education including group projects, virtual patients and virtual clinics. This encourages interactive learning.
E-learning in undergraduate medical education
I discussed with many Foundation Year one doctors who have graduated from different medical schools across the country. I have observed that the usage of e-learning is variable between medical schools. They felt that e-learning enhanced their learning in basic medical science like anatomy. Multimedia graphics helped them as they felt that the laboratory demonstration in it self was not sufficient for learning. In clinical medicine they felt that e-learning was beneficial in problem based case discussions and case presentations.
E-learning has the potential to enhance the learning instead of simply presenting the information. Examples of beneficial multimedia may include a video clip, computer animation for explaining the underlying patho physiology and images of investigations like chest x ray or endoscopy pictures. I have observed that some e-learning using multimedia technology detract the learner from the key message that the teacher wanted to convey and this should be avoided. Physical skills are best learnt by performing them under direct supervision. E-learning, however, can be used to augment the teaching of practical skills. A video showing the technique will be helpful in priming the learner prior to attending a teaching session.
Another interesting development in medical education is the application of 'virtual patient'. Examples in this category include a video of clinical consultation to illustrate history taking or examination skills or for demonstrating a physical sign. This is useful for demonstrating certain clinical conditions which the student is unlikely to encounter during their short stay in certain clinical attachments like dermatology or rheumatology. Virtual patients can be used to teach the skills of diagnostic reasoning and patient management through interactivity. There are packages available which allows the student to take a virtual history from a bank of questions and this is followed by examining the patient. This can be artificial and I believe this is better learnt bedside.
We have to acknowledge that most of the learning that occurs in clinical practice is 'opportunistic' and technologies which could bridge the gap in experience will be beneficial.
Assessment and feedback in e-learning
Assessment and feedback are important elements of medical education. Time logged on to the website and accessing the e-learning modules can be monitored as a part of formative assessment. Formative or summative assessments in e-learning courses can be carried out using Multiple Choice Questions and Extended Matching Questions. Multimedia enhanced virtual patient case scenarios can be used for assessment followed by Multiple Choice Questions or diagnostic reasoning tests. Care must be taken to include all possible correct answers in diagnostic reasoning tests because programming can be technically challenging. I have some reservations in using e-learning summative assessments as the identity of the student can not be guaranteed and may encourage cheating. Feedback in e-learning is limited to correction of mistakes and it is difficult to provide detailed feedback.
Evidence for e-learning in medical education
Cook et al 2008 conducted a systematic review and meta-analysis of internet based instruction in medical education. They have concluded that e-learning is better than no intervention and as effective as traditional education. They have also concluded that there is no evidence to conclude that e-learning is better than traditional education. Clark 2002 has demonstrated that students are very satisfied with e-learning. Students, however, do not see e-learning replacing instructor-led training but as a complement to it, forming a part of a blended learning strategy.
Advantages and disadvantages of e-learning
E-learning has many advantages. The learner can schedule the learning around their personal and professional life minimising disruption to their day to day life. E-learning allows the learner to choose the learning material which is beneficial to them. The learner can pace their learning which suits them best. They will be able to contact their colleagues and teachers in discussions which can happen synchronously or asynchronously depending on the nature of the discussion. E-learning encourages the learner to take responsibility to their learning.
The disadvantages of e-learning are as follows. There is a considerable start up cost as well as maintenance cost and this should be taken in to account when setting up an e-learning programme. As learners are responsible for their learning unmotivated learners and learners with poor study habit may find it difficult to progress. There is added responsibility for the facilitator to be available on demand. Students may feel socially isolated, however, blended learning overcomes this issue. Slow or unreliable internet connection can be challenging as most multimedia content needs fast internet connection.
E-learning has become an integral part of medical education starting from undergraduate medical education to the continuing professional development of the practising clinicians. Like other teaching methods, e-learning has its own strengths and weaknesses and need to be used appropriately. E-learning has the potential to shift the balance form teaching to learning. Basic computing skills are essential for e-learning. The range of e-learning activities varies from e-books to co-ordinated project works. Studies have shown that the results of e-learning methods are comparable to traditional teaching methods in undergraduate medical education. To be successful e-learning has to be combined with traditional teaching methods as a blended approach as practice of medicine involves 'real patients' not 'virtual patients'. E-learning is also playing an important role in the development of postgraduate trainees and life long learning of practicing clinicians. E-learning certainly has the potential to enhance the learning in medical education, if used appropriately.