Educational technology has been defined by the Association for Educational Communications and Technology (AECT) as “... the study and ethical practice of facilitating learning and improving performance by creating, using, and managing appropriate technological processes and resources” (Hlynka and Jacobsen, 2009).  This is in contrast to information technology (IT), which is defined “as the technology involving the development, maintenance, and use of computer systems, software, and networks for the processing and distribution of data” (Merriam-Webster online, 2017).  Despite having remarkably different roles and domains, the two are commonly used interchangeably, in error.

Even though educational technology as a domain of practice and study has existed for decades (Saettler, 1967), integrating educational technology into the medical curriculum has just recently come to the forefront as a learning priority for the Royal College of Physician and Surgeons of Canada (RCPSC).  Their CanMEDS Roles Framework consists of seven core competencies that a practicing physician needs to acquire by the end of clinical training: medical expert, communicator, collaborator, leader, health advocate, scholar and professional (Frank, Snell, Sherbino, 2015).  The CanMEDS eHealth Expert Working Group Report revised CanMEDS 2015  to integrate technology competencies across the all Competency Roles, an acknowledgment of the substantial role technology plays in all domains of the clinician’s practice (Ho, Ellaway, Littleford, Hayward, and Hurley, 2014).  This group examined each of the CanMEDS Roles “through the lens of eHealth to provide advice and guidance,” in order that resident physicians and medical educators consider technology as an integrated part of medical practice (Ho et al., 2014).  

This paper presents a lens for the medical educator to view educational technology, i.e. to consider possible professional roles for successfully navigating educational technology systems, tools, services, and processes.  It further proposes a framework that supports a more interdisciplinary approach to medical education, while shedding light on the field of educational technology for medical educators facing these and other challenges.

In 2000, Bates identified the “lone ranger” in education as the teaching faculty member developing material on his/her own without professional staff support.  Bates (2000) associates the “lone ranger” approach with poor use of faculty time, loss of opportunities for integration, and a lack of technological sustainability.  Along the same lines, Schneider (2009) challenged design-oriented educational technologists to “adopt an interdisciplinary approach that will ultimately lead to better pedagogical designs in a given area,” along with a “humanistic approach [that] recognizes the individual learners…” and the belief that “[instructional design] procedures can be effective for either an academic or a training situation.”  

Schneider’s interdisciplinary approach, however, was not reflected in the Future of Medical Education in Canada’s Report entitled, Information and Educational Technology in Postgraduate Medical Education (Ellaway, Topps and Bahr, 2011).  In their review, Ellaway, Topps and Bahr (2011) found that the adoption of digital media and methods to be very uneven, and they identified a number of serious issues related to technology, including medical educators in Postgraduate Medical Education (PGME) developing and innovating in silos, rather than collaboratively.  They called for “better standards” as a way to remediate challenges related to quality and process in PGME.  However, notably absent among their recommendations was enhanced interdisciplinarity in medical education with educational technologists, missing the need to work collaboratively altogether.  Even the very title of the report conflates IT and educational technology.

Medical educators are not alone in this confusion around how technologists can be of assistance in delivering high quality medical education.  Educational technologists may also think of their job in a relatively limited way.  For example, Ritzhaupt, Martin and Daniels’ (2009) educational technology profile is focused on specific skills and technologies. This approach gives a very fragmented picture of the profession.  At the same time however, the Association for Educational Communications and Technology (AECT) point to high level processes and values, and not simply hardware and software (Hlynka and Jacobsen, 2009, quoted above). Han, Resch and Kovach (2013) echoed the AECT definition, and argued that “educational technology should be valued in terms of how well the technological process informs and facilitates learning.”  This connects an expanded and evolving view of educational technology with the world of medical education.

Meanwhile, approaches to delivering high quality education involving technology continue to expand.  In regard to resource development, one important change has been the emergence of user-created content. As noted by Hlynka and Jacobsen (2009), “the contemporary convergence of [content creation] tasks is one of the major characteristics of the first decades of the 21st century, for better or for worse.  Anyone can produce a video for YouTube; everyone is their own editor.” The implication is the medical educator working today (un)knowingly takes on multiple roles, including Developer and Project Manager, as the YouTube video example implies.  

The Designer role may be another. Thinking across the medical educator divide, van de Grift and Kroeze (2016) called for design thinking to augment medical professionals’ skills in basic and clinical sciences with design skills, to be applied in clinical and also medical education contexts.

As a strategy to access rather than possess these content-related competencies, Robin, McNeil, Cook, Agarwal, and Singhal (2011) call for faculty to engage with “a variety of experts [including] instructional design and educational technology, and ...teams composed of e-learning specialists, web designers, and videographers [to] support the design and development of new instructional materials while guiding medical school faculty in the use of new technologies.”

In parallel developments, Verma et al. (2009) applied a competency model based on CanMEDS to the regulated and unregulated professions of medical radiation technology, social work, pharmacy, and psychology, and argue for a “cultural shift from discipline-based silos to a common language for ascertaining the skills, knowledge, and attitudes needed to function in interprofessional teams.”  

The stage is set for medical educators to begin, or continue, to work in a more interdisciplinary manner with educational technology groups already in their faculty who already have the required competencies, but who may be underutilized.  This paper presents a role-based framework for educational technology competencies in medical education and is a logical continuation of the existing work, bringing together the fields of medical education and educational technology.

Academic Technologies, in the Office of Education, Faculty of Medicine and Dentistry, at the University of Alberta, is a “faculty-central resource that supports teaching and learning with technology in the Faculty of Medicine & Dentistry by developing educational resources, supporting core systems, providing workshops and training, and collaborating on research and service endeavours with members of the faculty and the wider community” (https://www.ualberta.ca/medicine/programs/actech).

Since the time of Academic Technologies inception in 2012, a continued lack of awareness amongst faculty, as to the what can be offered in terms of educational technology support, has been continuously observed. It has become clear that time-constrained medical educators are unlikely to read complicated educational technology competency profiles. Connecting the right educational support, with the faculty members who require it, proves difficult in practice.

Meanwhile, it was becoming apparent that the work in academic technologies involved not only competencies but also roles.  Working with Canadian physicians, the idea arose of describing educational technology in terms similar to the CanMEDS roles in order to present this work in a format familiar to physicians. The intention was to enable access and integration of educational technology in their teaching and assessment across all levels of medical education.  The CanMEDS framework was used as a base model due to its already accepted interdisciplinary status, as evidenced by its uptake in allied health professions, including pharmacy (Canadian Council for Accreditation of Pharmacy Programs, 2006) and occupational therapy (Canadian Association of Occupational Therapists, 2007), among others.  It is not necessarily an endorsement of the CanMEDS framework.

Therefore, a competency profile was developed for the educational technologist comprising seven roles, based on the authors’ and collaborators’ professional knowledge and experience, along with a scoping review of the literature.  The search strategy included the databases of ERIC (on OVID), PubMed and Google (first ten pages) and included the terms: ("educational technolog*" OR "instructional technolog*") AND ("medical education" OR "clinic* education").

To enhance the literature search, the next step was consultation with educational technologists, academic faculty and medical educators, as the prime purpose of the model was to raise awareness and dialogue rather than define the roles and competencies authoritatively.  The roles and competencies are, thereby, rooted in extensive practical experience.  Further group consultation with local educational technologists and academic medical educators refined the proposed framework until consensus was reached.

Hybrid Structure

Based on our findings, a hybrid structure of seven professional roles constellated around a central role of educational technologist emerged. The structure is adapted with permission from the CanMEDS diagram and framework (used by permission from the RCPSC).  

The proposed roles are: Educational Technology Expert, Leader, Educator, Administrator, Developer, Designer, and Collaborator. Each proposed role has a definition, list of competencies and example activities.  A description of each role is provided along with key concepts highlighted.  

The role definition follows CanMEDS closely, highlighting professional values and aspirations. Collaborator and Leader roles were retained, as was the notion of a central expert role. Since design thinking should be fundamental to all aspects of educational technology, we diverged from the CanMEDS roles to accommodate a Designer role.  This is unlike Verma et al. (2009), who used the same Roles as CanMEDS. Furthermore, to better describe our work we used Developer, Administrator, Designer and Educator roles rather than the CanMEDS Scholar, Professional and Health Advocate roles.

We further substituted enabling competencies with “example activities” because

• Examples are more concrete, easier to grasp, and less open to interpretation than competencies and thus better for illustrative purposes

• They are intended only to indicate the range of activities possible, not required and not necessarily available in a given medical school.

Competencies and example activities come from our own practice, and are consistent with the kind of competencies identified in educational technology frameworks such as Ritzhaupt’s (2009), but are more focused on medical education. (see appendix for examples)

Figure 1.  Role-based framework for the Educational Technologist Specialist
Adapted with permission from CanMEDS Diagram © 2015. The Royal College of Physicians and Surgeons of Canada. http://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e.  

Proposed Educational Technology Roles

Educational technology expert

Educator role

Administrator role

Leader role

Designer role

Developer role

Collaborator role

A new framework

Built upon the CanMEDS framework, this newly proposed roles’ framework is readily identifiable to the medical educator and should facilitate integration and build the needed technological bridges between multiple disciplines.  

Integrating educational technology with medical education has been a decades’ long struggle.  The roles of Education Technology Expert, Educator, Administrator, Leader, Designer, Developer and Collaborator are now clearly defined, with outlined competencies and example activities for each role.  

In our experience, but not well represented in the literature, medical educators and faculty typically require technology support as follows:

• creating/distributing/managing digital assets

• technology integration in adult learning

• patient information design

• vendor relations

• other activities

Armed with this framework, and considering that aspects of all the proposed roles may be applied to each of these challenges, the medical educator may become more readily aware of possibilities: to acquire more competence personally or seek the assistance of an educational technology group.  This aligns with Verma et al.’s (2009) assertion “common language using core competencies for health professionals may be used to drive the cultural shift needed to reduce individual liability and to transcend the hierarchy in health care.”  The implication is medical educators would do well to bolster their own competencies as needed for the educational technology task, and know when to collaborate with the educational technologist.

Roles mapping onto jobs

An important difference between this educator technologist framework and the CanMEDS framework is that unlike physicians, individual educational technologists are not expected to have all the competencies in all the roles.  Furthermore, the list of competencies in CanMEDS is finite, whereas for the educational technologist as envisaged here the list is potentially infinite.

Ritzhaupt et al.’s (2009) educational technology profile listed 40 different knowledge areas, 21 skill areas and 23 ability areas.  All of these tasks can be associated with one or more roles; for example, “Cognitive theories of learning” pairs with Educator, “Interpersonal communication” with Leader and Collaborator, and so on. The difference between our framework and the “traditional” educational technology profiles is the grouping by role provides a higher level categorization than either “generic” Knowledge/Skills/Attitudes, as seen in Ritzhaupt et al. (2009), or by specific workplace skills, such as “using Photoshop” or “using javascript”. Using this framework simplifies the profile into its requisite roles.

This framework helps describe to the medical educator what tools, perspectives and values the educational technologist may bring to the task.  When entering a project or teaching situation, it is not expected that the project will be broken down into these specific roles, but the medical educator will be able to describe his or her need in a way that can be better understood by those providing support.  By doing so, both parties will be speaking a common language, which will lead to better outcomes, in keeping with the rationale of Verma et al (2009), as mentioned above.  

In our experience, the “roles perspective” not only fits the support function of an educational technolgy group, but also encourages collaboration and empowerment of faculty, and capacity building in the campus community and beyond. The roles perspective pushes beyond “traditional” research roles and “traditional medical education” topics into a new, interdisciplinary space.  This area is also ripe for further study.

Connecting “roles” with humanist values

When we consider ourselves acting in a role, we imagine ourselves interacting with other people; for example, as Educator, we interact with learners, evaluators and administrators. Thus roles ground our activities, and competencies, into our human relationships.  Medical educators have traditionally thought of technology as part of the teaching toolbox but not integrating with other professionals, systems or resources. We are arguing for these to be integrated and that thinking in roles moves this goal forward.  Covey (1989) developed a time-management strategy based on identifying one's own personal and professional roles, as part of a strategy and practice of ethical  and principles-based decision-making as being sustainable and effective in the management domain. This could be relevant to operationalizing CanMEDS in physician and medical educator roles.

Medical educators can typically identify the Educational Technology Expert role: demonstrating and troubleshooting software and devices, while following relevant technological trends et cetera.  And medical educators may appreciate the Educator and Administrator roles, for example in the development of online learning and providing day-to-day support of systems.  What is not readily apparent are the roles of Leader, Developer, Designer and Collaborator.  Not realizing these underlying roles, the medical educator struggles and projects tend to go unfinished or take longer than time permits (Bates, 2000; Care, 2001).  Collaborating early on projects with the educational technologist can abate frustration and lead to greater technological integration and success, as evidenced by Robin et al. (2011).

Philosophical perspective

“Is it better to be in balance with technology, or for technology to be our master?”  This is a serious question at a significant juncture.  Evidence is emerging we are not necessarily winning. In 2015 the Alberta Teachers' Association, in association with Harvard Medical School, reported longitudinal findings (McRae, 2016) of increased anxiety and feelings of isolation associated with the use of technology, albeit along with its known benefits.  The ongoing study is finding that balance with technology in our lives is an overriding concern, especially for teachers.

From our perspective, a key role for any educator in the Western world involves dealing with technology. In 2015 the Royal College introduced technical competencies for residents  (Ho, Ellaway, Littleford, Hayward, and Hurley, 2014), but so far for medical educators neither technical competencies nor interdisciplinary roles have been addressed.

We are arguing for an increased intentionality around the roles we as teachers play with technology. Roles embody our humanist valuing of relationship, roles involve relationships with people in a way competencies don’t. And technology is a measure and a tool of our actual practice. Therefore roles and technology go hand-in-hand, as we consider how we teach and what things mean. It is an invitation to go beyond roles as merely “themes or meta-competencies” (Frank, 1996), rather to identify and reflect on our roles as a means of empowerment of self and others.

The intention of this paper is to support the empowerment of medical teachers everywhere by supporting ultimately a role-based consideration of medical education.  

Applications of the role-based educational technology profile could have a broad scope:

• For medical educators and educational technologists to have more informed, meaningful and effective interdisciplinary dialogue

• For educational technologists to be hired, be assessed, or self-assess

• For medical educators, educational technologists, and all stakeholders involved in medical education (learners, decision makers) to expand their frame of reference concerning educational technology

Strategies could be devised to support these activities for a more reflective, collaborative, and communicative practice among all those involved in medical education around the use of educational technology.

Arguably the most important application, however, would be at the level of institutional planning. These, and possibly other roles, could be considered when support units are being constituted for supporting medical education. Thus not only can the various competencies be provisioned, but there could be more leveraging of synergies amongst educational stakeholders within the institution to make this happen. This could take the form, for example, of more strategic partnering between design, technology and medical education programs.

Although grounded in the existing literature and in our experience as an academic office, this framework does have its limitations.

1. The framework is speculative and based on the experience in only one Canadian academic institution. It has not been validated broadly.

2. Like CanMEDS, this profile is not directly useable for assessment purposes.

3. Institutional, departmental and faculty-level organization and expectations vary widely and this framework may have generalizability issues.

4. A given educational technology support unit may or may not recognize these roles, competencies and activities as being its own, in terms of mandate.

5. A given group may or may not have all the given competencies represented.

Moreover, it needs to be acknowledged the descriptions and characteristics of roles described in this model are highly abridged, and other interpretations are possible.  For example, the presentation of the Designer role only touches on key points in this huge field of inquiry and activity, which has its own disciplines and subdisciplines. Much more could be said about all these roles, but not in the scope of this article.  

The intended take-away is not the content of the roles and competencies proposed here, but rather the concept that roles can be a useful way for clinician educators to think of and engage with educational technology and technologists.

Despite being surrounded by technology, medical educators struggle with its integration into daily teaching and assessment.  With the move to competency-based medical education, and Canada’s Competence by Design, clinical faculty are encouraged to observe, coach, and report, residents in training, but methods for doing this are ever-more technology intensive, as the eHealth Expert Working Group’s work suggests (Ho et al., 2014).  As Ellaway et al. (2011) noted recently, “there is a need for improved research, scholarship and critical appraisal of the role of digital media and methods in PGME.”  This framework may be useful in that appraisal process.

Further studies are needed, of both quantitative and qualitative nature, to explore questions such as:

• the generalizability of these findings

• to what extent exposure to the framework does or does not change the professional practice of clinician educators, educational technologists, administrators, and others

• potential governance and management implications of a role-based competency profile for educational technologists

• and more generally, whether a roles paradigm sheds light on the lived experience of the stakeholders involved with technology in medical education.

Using the MedEdPublish platform for dissemination of this work, the authors greatly encourage ongoing dialogue  in the reviews’ section about the proposed framework, particularly regarding the details of the proposed roles and competencies, and more general the framework’s applicability.  This will lead to broader validation and may lead to further study based on the feedback received.

The real test will be to what extent medical educators use the framework to think about their own practice and what roles do they see being relevant.

CanMEDS Diagram © 2015 The Royal College of Physicians and Surgeons of Canada. http://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e. Adapted with permission.