Research article
Open Access

Presenting the outline of a proposal for a 5 part program of medical education research using eLearning or Technology enhanced learning to support Learning through the continuum of Undergraduate, through Postgraduate to Lifelong learning settings

Poh Sun Goh[1]

Institution: 1. Department of Diagnostic Radiology, National University of Singapore
Corresponding Author: Dr Poh Sun Goh ([email protected])
Categories: Medical Education (General), Research in Medical Education, Technology
Published Date: 07/12/2016

Abstract

The purpose of this article is to present the outline of a proposal for a 5 part program of medical education (MedEd) research using eLearning or Technology enhanced learning (TeL) to support Learning through the continuum of Undergraduate, through Postgraduate to Lifelong learning settings.

Keywords: eLearning; Technology enhanced learning; Continuum of learning; Radiology

Background

Professional training programs are faced with the constant challenge of exponentially increasing curricular content, or curricular "bloat", crowding out curricular time allocated for student interaction and content assimilation, not to mention content integration.

The paradox is that professional training programs are lengthy multiyear, if not decade long training and apprenticeship encounters (Figure 1). As educators, we have not taken full advantage of the potential of educational technology to provide access to comprehensive, standardised, peer-reviewed, high quality content for both students, and instructors; during this lengthy training process. To revisit, and build upon fundamental principles and case-based experience; utilising the best available educational theory, including mastery training and deliberate practice principles, evidence from the literature, as well as local empirical experience. We have also not taken full advantage of the potential of educational technology and eLearning to make our teaching public, scholarly, and a showcase of educational scholarship. 

In the next 5 studies, as part of a "PhD level" educational proposal, the role of educational technology, eLearning or technology enhanced learning will be reviewed in the context of a longitudinal medical training program, spanning the undergraduate, through postgraduate, to continuing professional development and lifelong learning settings. A series of studies will be proposed to evaluate, assess, and measure the impact of these educational efforts in revising a training curriculum.

I have chosen in this paper, for the purpose of brevity, and readability, to focus on presenting the outline of a planned proposal for a multiyear educational research program.  Sections are deliberately "incomplete" with regard to a full set of supporting references. The intention is for this paper to followed by 5 more detailed proposals where a full review of what is known will be articulated, followed by the study proposal, and discussion of where and how this might add to the existing literature. This paper can also be read as complementary to / and a follow up to the paper - Goh, P.S. The value and impact of eLearning or Technology enhanced learning from one perspective of a Digital Scholar. MedEdPublish. 2016 Oct; 5(3), Paper No:31. Epub 2016 Oct 18. http://dx.doi.org/10.15694/mep.2016.000117 (as continuation of a "scholarly conversation" arising from reviewer comments and suggestions by Ken Masters, and my response describing further work following from this).

Study 1 and 3 - eLectures vs traditional Lectures in undergraduate (study 1) and postgraduate (study 3) medical education

Lectures can (1) provide an efficient and time effective way to share complex information with large groups of students in an enthusiastic and engaging way; (2) present a framework to facilitate understanding and provide an introduction and overview of complex topics, helping integrate prior knowledge with current information for students; (3) customise the material for a specific cohort of students to address their learning needs; (4) be used to provoke thought and deepen understanding; and (5) be used to promote independent learning (Brown & Manogue, 2001; Exley & Dennick, 2004).

eLectures possess many of the advantages of traditional lectures; with the added functionality and advantage of widening access to high quality standardised peer reviewed content to both students and instructors; to learn from, and build upon (see background section).

A key advantage of making eLecture content available, in both packaged, and granular form (by indexing key take-home points, key tables and graphics and important references and review papers for example); is that students can review and revisit principles, and illustrative case studies repeatedly through their longitudinal training program (with timing and sequence both guided by instructors in an adaptive curriculum; and also on demand as and when required by students). This reinforces basic principles; and improves transfer (Baldwin & Ford,1988). The provision of eLecture content which students engage with repeatedly promotes learning.

eLectures can facilitate self-directed learning in students. eLectures offer curricular planners and educators greater flexibility to deliver and customise educational content, and facilitate an adaptive curriculum.

There are several ways we can evaluate and assess these assertions.

For example, for students, we can measure time to competency for undergraduates as an index for efficiency. We can measure time to proficiency, and mastery for postgraduates; as an index for efficiency. For both undergraduates, and postgraduates, we can assess understanding, knowledge retention, and ability to apply key ideas and principles as an indicator of effectiveness. For instructors, we can measure lecture preparation time as an index for efficiency. And assess the relative ease of evaluating teaching effectiveness using eLectures vs traditional lectures.

Study 2 - role of interactive eCases in undergraduate medical education

What is the role of interactive eCases in undergraduate medical education? Presenting typical examples of common clinical conditions serves to illustrate principles and key ideas introduced in the basic science units of a medical curriculum. More significantly, these clinical scenarios and case examples are the starting point of future clinical encounters, and serve as both knowledge anchors around which deeper experience can be built with exposure to further clinical case examples, as well as triggers to recall key practice points, while deepening understanding of basic science principles.

Students are progressively exposed to clinical scenarios illustrated with key points in the clinical history, physical examination findings, laboratory data and clinical imaging findings.

This process of building a firm foundation of clinical case based scenario recognition ("think fast", pattern recognition, or "what") supported by a firm foundation of increasing deeper understanding of basic science principles ("think slow" or "why") is fundamental to developing both forms of clinical reasoning, giving future clinicians the ability to quickly recognise common and important clinical scenarios, as well as the capacity and ability to reason from first principles with atypical clinical presentations, with less defined, multiple and conflicting clinical features (Kahneman, 2011).

Study 4 - role of interactive eCases in postgraduate medical education

Re-imagining a postgraduate training curriculum

A combination of eLectures (e=online; e=edited, 0.5 time traditional lectures), daily deliberate practice sessions with theme based interactive online sets of clinical cases for compare and contrast practice coupled with online and regular face to face feedback and discussion with clinical tutors; together with supervised daily clinical sessions with clinical teachers in a coaching role; augmented by individual resident ePortfolios for formative assessment and self reflection; can potentially dramatically reduce the training time required in postgraduate training programs, delivering a more personalised educational experience, focused on identifying an individual trainee's strengths and augmenting these, as well as strengthening areas of weakness in performance (Figures 2 and 3).

Study 5 - role of a hyperlinked indexed eRepository in continuing medical education

An eRepository, particularly one that is comprehensive, and representative of current, and actual teaching and training material, has a similar utility to that of a well stocked, well laid out, and clearly signposted and labelled grocery store or market, with a well stocked frozen food/prepared meal section. To take this food and cooking analogy further, this resource would allow a chef, or cooking instructor/demonstrator, to devote his or her time more efficiently, and potentially more effectively, by focusing effort on actual cooking and demonstrating, rather than sourcing for ingredients.

Translating this analogy to an education and training setting, the instructor can focus on customising a teaching and training program, and refining an educational offering; rather than spending time sourcing for material, creating content from scratch, or looking through past presentations and training resources to attempt to update or customise these for a particular audience.

This paradigm also facilitates personalised content review by learners, who now can not only review previously presented packaged presentations, but also go back to the original source material and "raw ingredients", for example clinical scenarios, take home points, key references, key points made in these references, key illustrations (including graphics, radiology images, anatomy and pathology digital photographs), charts and tables.

This promotes a modular, potentially more standardised, systematic and programatic; customised and personalised review of educational material; particularly with the aid of prepared curricular plans, and the assistance of teachers and trainers in a coaching role. Digital access and accessibility promotes and widens access to this educational and training material; facilitates formal, informal and just in time learning and performance support; anytime and anywhere. This resource supports content review before class. Valuable face to face time and live class time is now available for more interactive discussion with peers and instructors, with a focus on deepening understanding, translating theory to practice, using group interactions and other active learning strategies ("blended" eLearning with face to face interaction; and the "Flipped Classroom" model).

For example, the potential of "collections of potential training situations for a wide range of professional tasks" is discussed by (Anders Ericsson, 2009), where he suggests "using collections of representative tasks with verifiably correct answers", which can "not only be used to measure objective performance of experts", but can "be used for training new recruits as well as maintenance testing and continued training of experienced professionals" (Chapter 18, page 422-423).

Ericsson concludes with this suggestion, that "with an increased interest in the lifelong development of professional performance, there should be an increase in the studies examining deliberate practice in many different types of professional activities, as well as designing training environments with challenging relevant situations that require immediate action and that can provide feedback and opportunities for repeated encounters of the same and similar tasks" (Chapter 18, page 425).

Figure 1: Illustration of the continuum of medical education

Figure 2: Illustration of a "Hybrid" new (radiology) residency curriculum - Augmenting a traditional (radiology) residency with daily sessions of case-based (purposeful) deliberate practice with feedback

Figure 3: Illustrating the use of systematic purposeful deliberate practice to move performance curves "upwards" to higher levels of performance

Take Home Messages

eLearning or Technology enhanced learning (TeL) can be used to support Learning through the continuum of Undergraduate, through Postgraduate to Lifelong learning settings. The intention of this series of studies is to investigate the use, value and impact of TeL in different educational settings.

Notes On Contributors

POH SUN GOH, MBBS, FRCR, FAMS, MHPE, is an Associate Professor and Senior Consultant Radiologist at the Yong Loo Lin School of Medicine, National University of Singapore, and National University Hospital, Singapore. He is a graduate of the Maastricht MHPE programme, and current member of the AMEE eLearning committee. 

Acknowledgements

Bibliography/References

Anders Ericsson, K. (2009). Development of Professional Expertise -Toward Measurement of Expert Performance and Design of Optimal Learning Environments. Cambridge University Press.

https://doi.org/10.1017/CBO9780511609817

Baldwin TT, Ford, JK. (1988) "Transfer of training: A review and directions for future research" Personnel Psychology, 41(1): 63-105

https://doi.org/10.1111/j.1744-6570.1988.tb00632.x

Brown G, Manogue M. (2001). AMEE Medical Education Guide No. 22: Refreshing lecturing: a guide for lecturers. Med Teach. May; 23 (3): 231-244.

http://dx.doi.org/10.1080/01421590120043000

Exley K, Dennick, R. (2009). Giving a Lecture: From Presenting to Teaching. 2nd edition, Routledge.

Kahneman, D. (2011). Thinking Fast and Slow. Macmillan.

Appendices

Declarations

There are no conflicts of interest.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)

Reviews

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Barbara Jennings - (21/03/2019) Panel Member Icon
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This paper presents some great ideas about how learning should be supported through the early undergraduate years through to the specialist postgraduate career stages. Poh Sun Goh suggests strategies that could definitely relieve universal problems such as "curriculum bloat" and the challenge of sustaining lifelong scholarship. It is a very interesting read.
However, the manuscript would have to be revised before I would recommend it to others. In my opinion, it is not really a "research article" nor a research protocol. It would be better positioned as an opinion piece; or case study (if some of the ideas have been developed further); or as a review if the background literature is fully cited. In addition, it is unclear in a few places. In particular, the figures, titles, and legends seem to be in draft form and could be improved for a final version for publication.
Ken Masters - (08/12/2016) Panel Member Icon
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This is an interesting paper, and I look forward to the other papers that will arise from it, and expand in more detail. Because of the lack of some detail, it is difficult to assess the paper completely – for example, a statement like: “For instructors, we can measure lecture preparation time as an index for efficiency” could be highly problematic if merely taken at face value to mean, the longer a lecture takes to prepare, the less efficient is the use of time/the lecturer/etc. It is the promised later, expansion papers that, I am sure, will clarify this and other points made in the made. Nevertheless, the paper holds some useful and thought-provoking ideas that allow a reader to have an overview of e-learning/TEL across the curriculum.
Nandalal Gunaratne - (07/12/2016)
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This is an excellent open plan for someone keen to develop on e resources and teaching using them.

I find this gives useful ideas and plan to develop upon.