Stella Porto's List: medical & e-learning

"Eugene A. Stead, Jr., MD
Professor Emeritus
Department of Medicine, Duke University School of Medicine
Durham, NC 27710

Guest Editorial/Special Article

Using Distance Learning to Provide a Medical Education to Non-traditional Students

Throughout the country, colleges and universities are expanding their traditional programs to meet the needs of "non-traditional" students. It is time for accredited medical schools to do the same. They should establish distance learning curricula that would allow experienced community-bound health professionals, such as physician assistants (PAs) and nurse practitioners (NPs), to take medical school courses from home or at work. By doing so, they could build upon the talents of these "non-traditional" but seasoned clinical veterans to increase the number of practicing doctors in rural and medically underserved areas as rapidly and cheaply as possible.

There will always be a need for traditional four-year on-campus medical schools but these programs bypass a wealth of highly qualified health professionals who have the potential to better serve their communities. There have been situations in the past where medical schools have accepted advanced standing students based on prior knowledge and experience and have awarded these students medical degrees whenever they believed they were ready to take the medical practice qualifying examinations. About 35 years ago, before the age of space exploration, the market for Ph.D. graduates collapsed while the market for MD graduates remained robust.. A medical school in Florida decided that the first two years of the Ph.D. program covered the science requirements for medical practice and accepted Ph.D. students into the third year class of medical school. As physician-in-chief of Duke Hospital, I appointed several of these "fast-tracked MDs" to the resident staff. They performed as well and in some instances better than the students who had spent four rather than two years in medical school. "

"A new vision for distance learning and continuing medical education.
Harden RM.
Source

IVIMEDS, Dundee, Scotland, United Kingdom.
Abstract

Increasing demands on continuing medical education (CME) are taking place at a time of significant developments in educational thinking and new learning technologies. Such developments allow today's CME providers to better meet the CRISIS criteria for effective continuing education: convenience, relevance, individualization, self-assessment, independent learning, and a systematic approach. The International Virtual Medical School (IVIMEDS) provides a case study that illustrates how rapid growth of the Internet and e-learning can alter undergraduate education and has the potential to alter the nature of CME. Key components are a bank of reusable learning objects, a virtual practice with virtual patients, a learning-outcomes framework, and self-assessment instruments. Learning is facilitated by a curriculum map, guided-learning resources, "ask-the-expert" opportunities, and collaborative or peer-to-peer learning. The educational philosophy is "just-for-you" learning (learning customized to the content, educational strategy, and distribution needs of the individual physician) and "just-in-time" learning (learning resources available to physicians when they are required). Implications of the new learning technologies are profound. E-learning provides a bridge between the cutting edge of education and training and outdated procedures embedded in institutions and professional organizations. There are important implications, too, for globalization in medical education, for multiprofessional education, and for the continuum of education from undergraduate to postgraduate and continuing education."

"A review of evaluation outcomes of web-based continuing medical education.
Curran VR, Fleet L.
Source

Academic Research and Development, Faculty of Medicine, Memorial University of Newfoundland, St John's, Canada. vcurran@mun.ca
Abstract
INTRODUCTION:

The Internet and worldwide web have expanded opportunities for the provision of a flexible, convenient and interactive form of continuing medical education (CME). Larger numbers of doctors are accessing and using the Internet to locate and seek medical information. It has been suggested that a significant proportion of this usage is directly related to questions that arise from patient care. A variety of Internet technologies are being used to provide both asynchronous and synchronous forms of web-based CME. Various models for designing and facilitating web-based CME learning have also been reported. The purpose of this study was to examine the nature and characteristics of the web-based CME evaluative outcomes reported in the peer-reviewed literature.
METHODS:

A search of Medline was undertaken and the level of evaluative outcomes reported was categorised using Kirkpatrick's model for levels of summative evaluation.
RESULTS:

The results of this analysis revealed that the majority of evaluative research on web-based CME is based on participant satisfaction data. There was limited research demonstrating performance change in clinical practices and there were no studies reported in the literature that demonstrated that web-based CME was effective in influencing patient or health outcomes.
DISCUSSION:

The findings suggest an important need to examine in greater detail the nature and characteristics of those web-based learning technologies, environments and systems which are most effective in enhancing practice change and ultimately impacting patient and health outcomes. This is particularly important as the Internet grows in popularity as a"

"Learning in a virtual world: experience with using second life for medical education.
Wiecha J, Heyden R, Sternthal E, Merialdi M.
Source

Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA. john.wiecha@bmc.org
Abstract
BACKGROUND:

Virtual worlds are rapidly becoming part of the educational technology landscape. Second Life (SL) is one of the best known of these environments. Although the potential of SL has been noted for health professions education, a search of the world's literature and of the World Wide Web revealed a limited number of formal applications of SL for this purpose and minimal evaluation of educational outcomes. Similarly, the use of virtual worlds for continuing health professional development appears to be largely unreported.
METHODS:

We designed and delivered a pilot postgraduate medical education program in the virtual world, Second Life. Our objectives were to: (1) explore the potential of a virtual world for delivering continuing medical education (CME) designed for physicians; (2) determine possible instructional designs using SL for CME; (3) understand the limitations of SL for CME; (4) understand the barriers, solutions, and costs associated with using SL, including required training; and (5) measure participant learning outcomes and feedback. We trained and enrolled 14 primary care physicians in an hour-long, highly interactive event in SL on the topic of type 2 diabetes. Participants completed surveys to measure change in confidence and performance on test cases to assess learning. The post survey also assessed participants' attitudes toward the virtual learning environment.
RESULTS:

Of the 14 participant physicians, 12 rated the course experience, 10 completed the pre and post confidence surveys, and 10 completed both the pre and post case studies. On a seven-point Likert scale (1, strongly disagree to 7, strongly agree), participants' mean reported confidence increased from pre to post SL event with respect to: selecting insulin for patients with type 2 diabetes (pre = 4.9 to post = 6.5, P= .002); initiating insulin (pre = 5.0 to post = 6.2, P= .02); and adjusting insulin dosing (pre = 5.2 to post = 6.2, P= .02). On test cases, the percent of participants providing a correct insulin initiation plan increased from 60% (6 of 10) pre to 90% (9 of 10) post (P= .2), and the percent of participants providing correct initiation of mealtime insulin increased from 40% (4 of 10) pre to 80% (8 of 10) post (P= .09). All participants (12 of 12) agreed that this experience in SL was an effective method of medical education, that the virtual world approach to CME was superior to other methods of online CME, that they would enroll in another such event in SL, and that they would recommend that their colleagues participate in an SL CME course. Only 17% (2 of 12) disagreed with the statement that this potential Second Life method of CME is superior to face-to-face CME.
CONCLUSIONS:

The results of this pilot suggest that virtual worlds offer the potential of a new medical education pedagogy to enhance learning outcomes beyond that provided by more traditional online or face-to-face postgraduate professional development activities. Obvious potential exists for application of these methods at the medical school and residency levels as well."

"E-learning in surgical education and training.
Larvin M.
Source

Academic Division of Surgery, School of Graduate Entry Medicine and Health, University of Nottingham, Nottingham, UK. mike.larvin@nottingham.ac.uk
Abstract

For most surgeons and surgical educators, e-learning is relatively new and confusing. This article attempts to explain the key concepts behind e-learning, as well as its benefits and risks. E-learning has become a fixed feature within Higher and Professional Education and has been prioritized by Universities around the world, as well as all six Surgical Royal Colleges. Trainees have grown up with virtual learning environments and expect similar provision for their postgraduate studies, but have a greater need for basic science learning. Dispersal of trainees across duty rotas and geographically makes e-learning more attractive, but preserving peer and trainer communication is as important as content. Recent changes in surgical education and training have also made electronic and distance learning more attractive than previously. Initial work by the Colleges is now being evaluated and important lessons have emerged. The UK Department of Health has made medical e-learning a priority and it is now the largest e-learning provider in Europe. Changes in the World Wide Web, with a shift to more social-networking activity in education and to web-based delivery to small, ubiquitous portable devices will increase opportunities for surgical e-learning."

"Surgical education in the internet era.
Pugh CM, Watson A, Bell RH Jr, Brasel KJ, Jackson GP, Weber SM, Kao LS.
Source

Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Abstract

Technological advancements, along with economic and political issues, have resulted in major changes in surgical education. The development of high fidelity simulators and the widespread availability of the Internet have allowed learning to be shifted away from the operating room. Furthermore, the Internet provides an opportunity for surgical educators to standardize general surgery training and assessment and to develop collaborations nationally and globally. This paper highlights presentations about the challenges as well as the rewards of surgical education in the age of the Internet from the 2009 Academic Surgical Congress."

"Assessing the skills of surgical residents using simulation.
Tavakol M, Mohagheghi MA, Dennick R.
Source

Medical Education Unit, University of Nottingham, Nottingham, UK. mcxmt2@nottingham.ac.uk
Abstract

Much is still to be learned about the assessment of simulation-based surgical skills training. However, assessing surgery skills through simulation is a new horizon in medical education. Providing a safe environment for surgical residents to assess their performance rigorously without placing patients in jeopardy is valuable. Using simulators (both warm and cold) as a means to assess trainees has been established. However, also problems concerning the validity and reliability of such simulation-based assessment tools exist, particularly in surgery, that may need to be investigated even more to decide whether to use them as a tool for assessing the performance of surgical residents."

"Validation of laparoscopic surgical skills training outside the operating room: a long road.
Hogle NJ, Chang L, Strong VE, Welcome AO, Sinaan M, Bailey R, Fowler DL.
Source

Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
Abstract
BACKGROUND:

Surgical skills training outside the operating room is beneficial. The best methods have yet to be identified. The authors aimed to document the predictive validity of simulation training in three different studies.
METHODS:

Study 1 was a prospective, randomized, multicenter trial comparing performance in the operating room after training on a laparoscopic simulator and after no training. The Global Operative Assessment of Laparoscopic Skills (GOALS) was used to evaluate operative performance. Study 2 retrospectively reviewed the operative performance of junior residents before and after implementation of a laparoscopic skills training curriculum. Operative time was the variable used to determine resident improvement. Study 3 was a prospective, randomized trial evaluating intern operative performance of laparoscopic cholecystectomy in a porcine model before and after training on a simulator. Operative performance was assessed using GOALS.
RESULTS:

All three studies failed to demonstrate predictive validity. With GOALS used as the assessment tool, no difference was found between trained and untrained residents in studies 1 and 3. In study 2, the trained group took significantly longer to complete a laparoscopic cholecystectomy than the untrained group.
CONCLUSIONS:

No correlation was found between the three types of training outside the operating room, and no improved operative performance was observed. Possible explanations include too few subjects, training introduced too late in the learning curve, and training criteria that w"

"Critical issues in medical education and the implications for telemedicine technology.
Mahapatra AK, Mishra SK, Kapoor L, Singh IP.
Source

Department of Endocrine Surgery, School of Telemedicine and Biomedical Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India.
Abstract

Ensuring quality medical education in all the medical colleges across India based on uniform curriculum prescribed by a regulatory body and maintaining a uniform standard are dependent on availability of an excellent infrastructure. Such infrastructure includes qualified teachers, knowledge resources, learning materials, and advanced education technology, which is a challenge in developing countries due to financial and logistic constraints. Advancement in telecommunication, information science, and technology provides an opportunity to exchange knowledge and skill across geographically dispersed organizations by networking academic medical centers of excellence with medical colleges and institutes to practice distance learning using information and communication technology (ICT)-based tools. These may be as basic as commonly used Web-based tools or may be as advanced as virtual reality, simulation, and telepresence-based collaborative learning environment. The scenario in India is no different from any developing country, but there is considerable progress due to technical advancement in these sectors. Telemedicine and tele-education in health science, is gradually getting adopted into the Indian Health System after decade-long pilot studies across the country. A recent recommendation of the National Knowledge Commission, once implemented, would ensure a gigabyte network across all the educational institutions of the country including medical colleges. Availability of indigenous satellite communication technology and the government policy of free bandwidth provision for societal development sector have added strength to set up infrastructure to pilot several telemedicine educational projects across the country."

"Innovative computer-based learning for breast cancer surgery.
Wingfield KL.
Source

Cardiff Breast Unit, Cardiff and Vale NHS Trust, UK.
Abstract

Discussions with student nurses when they have been on placement on the breast cancer surgery ward highlighted their lack of knowledge about breast cancer surgery. This lack of knowledge by student nurses necessitated the development of a computer-based learning tool. A distance-learning tool was found to be an effective way of providing education, due to lack of facilities and workload on the ward. The student nurses using this tool will have better understanding of the treatments their patients are undergoing, leading to improved patient care."

"Defining useful surrogates for user participation in online medical learning.
Beddy P, Ridgway PF, Beddy D, Clarke E, Traynor O, Tierney S.
Source

Department of Surgery, Adelaide and Meath Hospital (AMNCH) incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland. pbeddy@eircom.net
Abstract

"School for Surgeons" is a web-based distance learning program which provides online clinical-based tutorials to surgical trainees. Our aim was to determine surrogates of active participation and to assess the efficacy of methods to improve usage. Server logs of the 82 participants in the "School for Surgeons" were assessed for the two terms of the first year of the program. Data collected included total time online, mean session time, page requests, numbers of sessions online and the total number of assignments. An intervention regarding comparative peer usage patterns was delivered to the cohort between terms one and two. Of the 82 trainees enrolled, 83% (85% second term) logged into the program. Of all participants 88% (97% second term) submitted at least one assignment. Median submissions were four (eight second term) per trainee. Assignment submission closely correlated with number of sessions, total time online, downloads and page requests. Peer-based comparative feedback resulted in a significant increase in the number of assignments submitted (p < 0.01). Despite its recent introduction, "School for Surgeons" has a good participation rate. Assignment submission is a valid surrogate for usage. Students can"

"Strategies for online teaching and learning: lessons learned.
Beitz JM, Snarponis JA.
Source

School of Nursing, La Salle University, Philadelphia, PA 19141, USA. beitz@lasalle.edu
Abstract

Distance learning and Web-based learning are accepted components of the American higher educational system. Strategies for teaching and learning in this medium require a different perspective on the teacher-student relationship and the educational process. The authors describe an innovative online learning endeavor focusing on a specialty practice area in contemporary healthcare: wound, ostomy, and continence nursing. Special emphasis is placed on the teaching-learning approaches that were successfully incorporated into the program."

"A surgical and fine-motor skills trainer for everyone? Touch and force-feedback in a virtual reality environment for surgical training.
Aschwanden C, Sherstyuk A, Burgess L, Montgomery K.
Source

caschwan@hawaii.edu.
Abstract

Access to the laboratory component of a class is limited by resources, while lab training is not currently possible for distance learning. To overcome the problem a solution is proposed to enable hands-on, interactive, objectively scored and appropriately mentored learning in a widely accessible environment. The proposed solution is the Virtual-Reality Motor-Skills trainer to teach basic fine-motor skills using Haptics for touch and feel interaction as well as a 3D virtual reality environment for visualization."

"Education and distance learning: changing the trends.
Merrell RC.
Source

Virginia Commonwealth University, Department of Surgery, USA. ronald.merrell@vcu.edu
Abstract

Training and instruction are activities deeply ingrained in human relations and derive from the critical need for the young to learn survival skills. The responsibility in primitive society for such training almost certainly fell to parents who continued their pedagogical role after childhood issues to include hunting, gathering, fine motor activities and other life skills needed for personal or family survival. Such instruction only ended when the young were ready for independent life and- contribution to tribal well-being. Delegation of teaching to others was inevitable. Teaching has become a specialty and has at least one interesting story in ancient literature. Ulysses was certain to be away at the Trojan War and subsequent adventures for many years. He would not be able to provide his son, Telemachus, with the guidance and training to prepare him for adulthood. Therefore, he asked Mentor to act In Loco Parentis and instruct the young man toward competence and adult success. Teaching as a profession and discipline has been through many stages and many controversies. Socrates was a great teacher with a distinct technique for learning by questioning. His influence on his students was profound. Plato was such a good student he recorded all the master's works. Socrates has never been credited with even the briefest lecture note. As great as he was Socrates was forced to drink the bitter hemlock because his teaching was considered a corruption of youth rather than a proper preparation for effective adulthood. Dissonance between the expectations of learners, parents and teachers has a rich history. Certainly even now education is not something the professoriate may invent for the naïve learner and then expect grateful acquiesce with faithful learning. Learning has -dimensions in human psychology and communication. The learners' autonomy, privacy and motivation cannot be denied. Learning is collaboration with teacher and the endpoint is the acquisition of new knowledge or skill."

"Web-based learning in undergraduate medical education: development and assessment of an online course on experimental surgery.
Bernardo V, Ramos MP, Plapler H, De Figueiredo LF, Nader HB, Anção MS, Von Dietrich CP, Sigulem D.
Source

Health Informatics Department-Distance Learning Laboratory, Federal University of São Paulo, Rua Pedro de Toledo, 781-2 degrees andar, 04039-032 Vila Clementino, Sao Paulo, Brazil. vivi@dis.epm.br
Abstract

In order to increase the number of practical and discussion classes offered to students in the traditional-curriculum scenario, while decreasing the lecture-based ones and to create an online community to share knowledge on surgery, we developed and assessed the first online course for undergraduate medical students on experimental surgery at the Federal University of Sao Paulo-UNIFESP, Brazil. The purposes of the present study are: describe and discuss the process and the lessons learned involved in developing an undergraduate web-based course and analyze the students' attitude towards this educational environment. A group of medical students was taught online during 5 weeks on the theory of experimental surgery through video quizzes, required readings, collaborative activities using discussion board and asynchronous communication. The students' knowledge gain, their web session variables and the results of the course evaluation were used to support our study. The students have significantly improved their knowledge on experimental surgery after the course. Among factors in the online course that could possibly have contributed to this gain, the interactive activities (video quizzes), key element in our online material, seemed to be promising for candidates. The evaluation results demonstrated high levels of course functionality, effectiveness of its online content and acceptance among medical students. This study indicated that a web-based course for undergraduate students may be successfully developed and implemented in medical settings and the students seem to be quite supportive. We encourage undergraduate medical learning strategies involving the Web."

"Virtual surgical telesimulations in otolaryngology.
Navarro Newball AA, Hernández CJ, Velez JA, Munera LE, García GB, Gamboa CA, Reyes AJ.
Source

Pontificia Universidad Javeriana, Cali, Colombia.
Abstract

Distance learning can be enhanced with the use of virtual reality; this paper describes the design and initial validation of a Web Environment for Surgery Skills Training on Otolaryngology (WESST-OT). WESST-OT was created aimed to help trainees to gain the skills required in order to perform the Functional Endoscopic Sinus Surgery procedure (FESS), since training centers and specialist in this knowledge are scarce in Colombia; also, it is part of a web based educational cycle which simulates the stages of a real procedure. WESST-OT is one from the WESST family of telesimulators which started to be developed from an architecture proposed at the Medicine Meets Virtual Reality conference 2002; also, it is a step towards the use of virtual reality technologies in Latin America."

"[Changing the teaching of neurosurgery with information technology].
[Article in French]
Moreau JJ, Caire F, Kalamarides M, Mireau E, Dauger F, Coignac MJ, Charlin B.
Source

Service de neurochirurgie. CHU Dupuytren, F-87042 Limoges, France. moreau@unilim.fr
Abstract

A digital campus is a distance learning site that uses the potential of information and communication technologies to disseminate and improve educational services. This website, with open and free access, is built from free software with Web 2.0 technology. It is hosted at the University of Limoges. It functions as a digital library, containing scanned books, slide shows, more than 200 hours of recorded courses and round tables accessible by streaming video. The site is indexed according to the users' needs, by level of knowledge, specialty, keywords, and supplementary MeSH terms. The campus is organized as the College of Neurosurgery (http://college.neurochirurgie.fr). The durability of this type of training (in existence for 9 years now) is made possible by a powerful and committed consortium: the French Society of Neurosurgery, which has created high-quality intellectual and scientific resources, the University of Limoges, the Dupuytren University Hospital Center in Limoges, the region of Limousin, and the French-language Virtual Medical University, which have provided logistic and financial support. To target appropriate levels at various users, we distinguished four groups: medical students, neurosurgery students, neurosurgeons (continuing medical education), and students in allied health fields. All areas of neurosurgery are concerned. All the courses, including tests for self-evaluation and scientific meetings (organized with information and communication technologies) are digitally recorded for the site. The principles that make it possible for a medical discipline to organize around an online project are: a pedagogical conception of projects built in the form of models reusable by other health specialties; a stronghold within professional societies of the relevant specialties able to create high-quality intellectual and scientific resources; an organization by educational levels that can be extended transversally to other health disciplines; and free access to the digital campus, the durability of which depends on the dissemination and dynamism of its consortium."