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| INVITED REVIEW |
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| Year : 2019 | Volume
: 12
| Issue : 4 | Page : 147-151 |
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E-Learning in medicine: Current status and future developments
Matthias Schneider, Thomas Binder
Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| Date of Submission | 29-Sep-2019 |
| Date of Acceptance | 03-Oct-2019 |
| Date of Web Publication | 11-Nov-2019 |
Correspondence Address:
Matthias Schneider
Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Wien, Vienna
Austria
 Source of Support: None, Conflict of Interest: None  | 5 |
DOI: 10.4103/HMJ.HMJ_74_19
We are confronted with a rapid growth in medical knowledge. It has become more and more difficult for health care professionals to keep pace with the state of knowledge. At the same time teaching concepts have changed with a similar speed, propelled by the evolution of the internet, social media, and digital technology. Online education plays an increasing role in all stages of education and can help to overcome some of the difficulties that health care professionals encounter. E-Learning can be more effective, interactive, and adaptive to the needs of the learner. But most importantly, it is available anytime and anywhere. This article focuses on the different stages of learning in a physician's career and on new teaching concepts that are applying innovative technologies to improve education.
Keywords: E-learning, medicine, ultrasound
How to cite this article:
Schneider M, Binder T. E-Learning in medicine: Current status and future developments. Hamdan Med J 2019;12:147-51 |
| Introduction | |  |
We are confronted with a dramatic increase in medical knowledge. Seventy years ago, it took half a century to double medical knowledge. It is estimated that in 2020, it will only take 73 days.[1] As a consequence, it has become more and more difficult for healthcare professionals to become and stay competent. At the same time, teaching concepts have changed with a similar speed than the evolution of the Internet, social media and digital technology. Clearly, classic medical textbooks and conventional lecture-based training are losing ground. This article focuses on the different stages of learning in a physician's career and on the new teaching concepts that are applying innovative technologies to improve education.
| Stages of Medical Education | | |
In medical education, we must distinguish between the (1) university training of medical students, (2) residence/specialised training and (3) continued medical education of physicians after board examinations. The teaching approach, knowledge depth/scope, learning environment and the motivation of the learner vary greatly in these stages. During medical school, group- or lecture-based training is at the core of most curricula. The understanding and revision of basic physiological and pathophysiological principles have high priority. Importantly, students can fully dedicate their time to learning. While it should be the intention of students to become a competent doctor, the immediate motivation of students is often to pass their examinations.
This changes during residency training, where an increasing amount of learning takes place on the job. One-on-one training between a superior and the resident or from peer to peer becomes more important. With the 'burden' of clinical workload, night shifts and the need to balance work with private life, it is more difficult to set time aside for training and continued medical education. Institutions increasingly face the problem that they cannot fully meet the educational needs of their staff and lack resources to set up training programs for their residents. In this phase of education, many healthcare professionals rely on external seminars, conferences and workshops, which are often sponsored by the industry, medical societies and other organisations. In parallel, learning practical skills becomes increasingly more important. These skills can be basic such as electrocardiogram interpretation or advanced such as ultrasound, coronary angiography or abdominal surgery. In addition, there is a large need for instant information to help master clinical problems. Doctors should find and learn the educational 'bits' quickly and effectively. Aside from passing specialised board examinations, one of the main motivations to learn in this phase is the fear of failure and incompetence on the job.
Once doctors leave the hospital environment, they often become isolated from peer-to-peer learning, mentor-to-peer tutoring and structured institutional education. This gap is often filled by attending seminars, lectures and reading articles and looking for content on the Internet. To incentivise doctors, many countries have now adopted the concept of continuing medical education (CME) credits, which track the post-graduate training of healthcare professionals.
Clearly, online education plays an increasing role in all of these stages of education and can help to overcome some of the difficulties that healthcare professionals are confronted with. E-learning can be more effective, interactive and adaptive to the needs of the learner. However, most importantly, it is available anytime and anywhere.
| Online Education: Evolution and Forms | | |
In a broader sense, the term e-learning relates to all forms of electronic learning, this also includes CD-ROMS, apps, and other digital formats, and not only the internet. However, web based (internet) applications are by far the most commonly used types of e-learning. E-learning provides online modules that support the student to learn a certain content [Table 1]. However, web-based (Internet) applications are by far the most commonly used types of e-learning. E-learning provides online modules that support the student to learn a certain content. Its value and effectiveness is well documented in the literature. E-learning started its revolution years ago in language teaching. Online services such as DUOLINGO and BABBLE have millions of registered users. Initially, these platforms solely provided a flashcard service, meanwhile complex learning algorithms have been developed to optimise the success of learning.[2] To some degree, this type of learning can also be applied in medicine. Continuous repetition of facts, names or numbers, especially if provided in the form of 'spaced' learning, can be highly effective. Anatomy is a good example of an area where this form of learning can be applied. Therefore, digital technologies are on the rise in this and similar discipline.[3] A meta-analysis published in JAMA documents its dramatic effects on the learners.[4]
Basic modules of e-learning can be found in most online services. Early online services concentrated on text-based solutions. This was pioneered by UpToDate, which basically created an online textbook of medicine by collecting current medical knowledge. The book is written and kept up to date be renowned experts in each field. This approach clearly has the advantage that it reflects the medical 'status quo' and that information can easily be found. An association between the use of this service and better patient safety could already be shown in 2008.[5] The number of such resources and 'Wikipedia-like' applications is constancy growing. A recent meta-analysis stresses the positive impact of the use of online resources in clinical medicine.[6]
Many parallel developments have expanded the potential of e-learning. For example, the high-speed Internet has enabled us to apply various multimedia formats such as video-based teaching, webinars, virtual video classrooms and conference transmission.
Advances in video technology and editing technology have dramatically impacted e-learning. High-quality videos can now be created and edited at low cost. Not only is it possible to record lectures but even more important: It can bring the learner directly into the medical arena. Video-based e-learning allows users to virtually be in the operative theatre, the laboratory or wherever medicine happens. Pausing, forwarding, rewinding and endless repetition of the video content permit the learner to learn at his own pace (individualised learning). Ideally, with the help of editing, the teacher can make sure that the teaching point is brought across and that the overall quality is optimal. The teacher has the advantage that with a specific lecture, a much larger audience can be reached.[7]
The gaming industry, enhanced computer graphics and simulation technology also gave rise to a new category of e-learning platforms which specialise in gamification and virtual reality to transport content.
Developments and authoring tools offered the possibilities to create individualised apps with a wide range of functionalities. However, most importantly, the advent of the iPhone brought e-learning mobile. We can learn everywhere at any time.
Social media also played an important role. Peer-to-peer learning (i.e. chat rooms, group discussions and instant messengers) is possible over the Internet, and everyone of us can become a teacher.
This has led to a democratisation of learning, while at the same time spurred competition. Not only are e-learning modules competing with traditional learning methods but also with each other. The 'best teaching' now prevails. With e-learning, the student is in the driver seat and can learn from the best teachers even if he is a remote location. All of these factors have led to an explosion of the e-learning. A recent report estimates e-learning (in general) will become a 300 billion US dollar market (https://www.gminsights.com/pressrelease/elearning-market [Last accessed on 2019 Sep 26]). Health care e-learning alone is estimated to grow to 136 billion US dollars (https://www.businesswire.com/news/home/20170207005730/en/Online%E2%80%91Learning%E2%80%91Technologies-Boost%E2%80%91Global%E2%80%91Medical%E2%80%91Education [Last accessed on 2019 Sep 26]).
The enthusiasm for e-learning has also led to the development of more and more sophisticated software environments to embed the content. Modern learning management systems (LMSs) integrate several e-learning components such as flashcards, video, virtual classrooms, chat rooms and multiple-choice question (MCQ). Their positive impact on teaching success is not a surprise.[8],[9]
With the spread of mobile devices and a new generation of 'digital natives', both the supply and the demand for e-learning have grown tremendously over the past years.[10]
The worldwide availability of mobile devices and the Internet allows for learning independent of time and place. Content can be consumed h in the most remote areas of the world and 'on the go' in the subway when commuting to work. This led to new concepts such as microlearning and mobile learning where students can take short teaching sessions throughout day.
| Academics and E-Learning | | |
The worldwide breakthrough of online teaching was sparked by the massive open online courses (MOOCs) initiative in 2007. These courses combine videos, text resources and online interactions of students and teachers. In 2011, Stanford Professor Sebastian Thrun reached a record participation of 160,000 students with his course on artificial intelligence.[11] Large North American universities founded MOOC platforms, such as Coursera (Stanford University) and edX (Massachusetts Institute of Technology and Harvard). At first, it was speculated that MOOCs would replace traditional universities soon.[12],[13],[14] Recently, MOOCs are integrated into traditional learning concepts as one of several modules of a medical curriculum.[15],[16]
More and more universities are now combining classroom teaching with online learning. Different approaches have applied:
- Blended learning brings together online teaching and traditional classroom teaching. It can assure that students acquired a minimum of knowledge before they meet the expert. This can dramatically enhance the efficacy of teaching [17]
- Flipped classroom teaching is a scenario where the hard facts are studied by the students at home. The classroom is then used for problem-solving, practical training and question and answer sessions. This teaching approach has been shown to be highly effective [18]
- Just-in-time teaching is another form of blended learning, where the students study online, answer MCQs and thereby allow the teacher to adapt the in-person teaching session to the needs of the particular students.[19]
Many of these concepts are now also post-graduate training.
The application of online modules in universities has spread with the distribution of easy-to-use software, web-based tools to build flashcard services and free content management tools for educational purposes.
| Diagnostic Ultrasound – an Example for Successful Implementation of Online Education | | |
Healthcare professionals that work in the field of medical imaging and particular diagnostic ultrasound require a large amount of training. Not only do they need to know how to perform an exam, but they must also be able to interpret the images. Ultrasound is a growing technology, and the need to train more healthcare professionals is apparent. Miniaturisation of devices and improved imaging capabilities has moved ultrasound to the forefront of medicine. Handheld devices and point-of-care ultrasound are one of the most quickly devolving medical technologies. In addition, ultrasound is now used for more and more indications. Most medical universities do not consider this trend and do not yet incorporated ultrasound training into their curriculum. Most doctors learn ultrasound on the job, by mentor tutoring and/or by attending courses. The reach, availability and quality of this form of teaching are limited. This precondition was the starting point for the e-learning project initiated by 123sonography.com in cooperation with the Medical University of Vienna.
123sonography (https://www. 123sonography.com) offers CME-accredited online video ultrasound courses for a wide spectrum of ultrasound modalities. These videos include demonstrations (i.e. how to image), case examples, expert opinions and theoretical knowledge, which are required to perform and interpret ultrasound. The videos are incorporated into a LMS which provides additional reference materials such as factsheets, case videos and MCQs.
In the production of videos, much emphasis has been placed on high quality filming in a studio and at hospital locations [Figure 1]. Proven didactic principles are applied, which focus on practical issues and which engage the community. Since visual assessment is a key to learn ultrasound, many case examples are provided. Social media, webinars and mailing of free content are used to build and strengthen the community. To date, over 400,000 healthcare professionals use the platform to consume content and over 35,000 took a structured ultrasound course. The courses and its content are also used to train hospital staff and students of the Medical University of Vienna (reference Ars Docendi) and have been applied in crowd-based research to obtain information about the skills of users.[20],[21] 123sonography is now the largest platform of its kind in diagnostic ultrasound. | Figure 1: Professional video setup at 123sonography: (a) Interview situation, (b) Filming a procedure in the cath lab, (c) Studio setting filming US demonstrations (d) Professional camera equipment and an electronic 'slider'
Click here to view |
The 123sonography project demonstrates some of the key elements which help to successfully implement e-learning.
- Specialities where images and videos (such as ultrasound) are required to learn are an ideal target for e-learning
- Course material should incorporate many case examples to increase the caseload of learners (to which they often do not have access in their environment)
- Content must be adapted to the way users apply the Internet to learn. Traditional slides and lecture-based teaching have limited appeal in e-learning. The quality of the content is a key.
| The Future Developments of E-Learning in Medicine | | |
Clearly, e-learning will quickly grow in all areas of medicine. Not only will it play a major role in medical universities, most likely in the form of blended learning, but it will also become a key element in post-graduate training.
Several technologies and trends will promote this development reference to [Table 2].
One of these trends is individualised learning which adapts to the level of competence and style of learning. This will require LMS to analyze user preferences, knowledge, and needs to provide a learning approach, which is most effective for the individual learner. Artificial intelligence algorithms will play an important role here. The German company AMBOSS (reference) (www.amboss.com) is a recent example for an online teaching website that uses computer algorithms to improve medical students' learning ability.
Web-based simulation technology, which uses elements such as virtual reality and remote simulators, will help users to obtain practical knowledge. For example, desktop simulators for ultrasound, which allow the user how to scan, are already on the horizon (reference: https://sonosim.com).
Aside from technical innovations, e-learning will also need to engage and motivate users. In a way, this form of learning might be called 'Medutainment'. Learning is easiest when it is fun. 'Gamification' is only one of many ways to achieve this goal. Serious gaming describes an interactive computer-based application that teaches the user a skill or knowledge that can be applied in the real world. In medicine, a variety of games, especially in the field of simulation of clinical scenarios, have already been developed.[22],[23],[24]
Another way to engage users is by using elements applied in the filming industry such as storytelling, suspense and documentary-style filming. This together with the possibility of interactive videos, which link to other elements of learning from within the video itself, holds promise for the future.
In an extended sense, even peer-to-peer learning will be revolutionised by new technologies such as artificial intelligence. For example, the results obtained from artificial intelligence algorithms in diagnosis and patient management will also provide teaching to healthcare providers.[25]
| Conclusion | | |
It is foreseeable that teaching through e-learning and computers will provide more and more of what we know. While some might believe that artificial intelligence will replace health care professionals, e-learning will also help us to reach a higher level of competence. Competence, which is important to communicate with our patients. And at least here humans definitely have the edge over computers.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Densen P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc 2011;122:48-58.  |
| 2. | Tabibian B, Upadhyay U, De A, Zarezade A, Schölkopf B, Gomez-Rodriguez M. Enhancing human learning via spaced repetition optimization. Proc Natl Acad Sci U S A 2019. pii: 201815156. |
| 3. | Arantes M, Arantes J, Ferreira MA. Tools and resources for neuroanatomy education: A systematic review. BMC Med Educ 2018;18:94. |
| 4. | Cook DA, Levinson AJ, Garside S, Dupras DM, Erwin PJ, Montori VM. Internet-based learning in the health professions: A meta-analysis. JAMA 2008;300:1181-96. |
| 5. | Bonis PA, Pickens GT, Rind DM, Foster DA. Association of a clinical knowledge support system with improved patient safety, reduced complications and shorter length of stay among medicare beneficiaries in acute care hospitals in the United States. Int J Med Inform 2008;77:745-53. |
| 6. | Maggio LA, Aakre CA, Del Fiol G, Shellum J, Cook DA. Impact of clinicians' use of electronic knowledge resources on clinical and learning outcomes: Systematic review and meta-analysis. J Med Internet Res 2019;21:e13315. |
| 7. | Baessler F, Ciprianidis A, Rizvi AZ, Weidlich J, Wagner FL, Klein SB, et al. Delirium: Medical students' knowledge and effectiveness of different teaching methods. Am J Geriatr Psychiatry 2019;27:737-44. |
| 8. | Bientzle M, Hircin E, Kimmerle J, Knipfer C, Smeets R, Gaudin R, et al. Association of online learning behavior and learning outcomes for medical students: Large-scale usage data analysis. JMIR Med Educ 2019;5:e13529. |
| 9. | Wilson AB, Brown KM, Misch J, Miller CH, Klein BA, Taylor MA, et al. Breaking with tradition: A scoping meta-analysis analyzing the effects of student-centered learning and computer-aided instruction on student performance in anatomy. Anat Sci Educ 2019;12:61-73. |
| 10. | Kim KJ, Kim G. Development of e-learning in medical education: 10 years' experience of korean medical schools. Korean J Med Educ 2019;31:205-14. |
| 11. | |
| 12. | |
| 13. | Johnson L, Adams Becker S, Cummins M, Estrada V, Freeman A, Ludgate H. Higher Education. NMC Horizon Report. Texas: The New Media Consortium; 2013. |
| 14. | Stacey PP. The Pedagogy of MOOCs. Int J Innov Qual Learn 2014;2:111-5. |
| 15. | Maxwell WD, Fabel PH, Diaz V, Walkow JC, Kwiek NC, Kanchanaraksa S, et al. Massive open online courses in U.S. healthcare education: Practical considerations and lessons learned from implementation. Curr Pharm Teach Learn 2018;10:736-43. |
| 16. | Chen BY, Kern DE, Kearns RM, Thomas PA, Hughes MT, Tackett S, et al. From modules to MOOCs: Application of the six-step approach to online curriculum development for medical education. Acad Med 2019;94:678-85. |
| 17. | Hadie SNH, Simok AA, Shamsuddin SA, Mohammad JA. Determining the impact of pre-lecture educational video on comprehension of a difficult gross anatomy lecture. J Taibah Univ Med Sci 2019;14:395-401. |
| 18. | Røe Y, Rowe M, Ødegaard NB, Sylliaas H, Dahl-Michelsen T. Learning with technology in physiotherapy education: Design, implementation and evaluation of a flipped classroom teaching approach. BMC Med Educ 2019;19:291. |
| 19. | Dominguez M, DiCapua D, Leydon G, Loomis C, Longbrake EE, Schaefer SM, et al. A neurology clerkship curriculum using video-based lectures and just-in-time teaching (JiTT). MedEdPORTAL 2018;14:10691. |
| 20. | Schneider M, Aschauer S, Mascherbauer J, Ran H, Binder C, Lang I, et al. Echocardiographic assessment of right ventricular function: Current clinical practice. Int J Cardiovasc Imaging 2019;35:49-56. |
| 21. | Schneider M, Ran H, Aschauer S, Binder C, Mascherbauer J, Lang I, et al. Visual assessment of right ventricular function by echocardiography: How good are we? Int J Cardiovasc Imaging 2019. doi: 10.1007/s10554-019-01653-2. [Epub ahead of print]. |
| 22. | Gorbanev I, Agudelo-Londoño S, González RA, Cortes A, Pomares A, Delgadillo V, et al. A systematic review of serious games in medical education: Quality of evidence and pedagogical strategy. Med Educ Online 2018;23:1438718. |
| 23. | Duque G, Fung S, Mallet L, Posel N, Fleiszer D. Learning while having fun: The use of video gaming to teach geriatric house calls to medical students. J Am Geriatr Soc 2008;56:1328-32. |
| 24. | Knight JF, Carley S, Tregunna B, Jarvis S, Smithies R, de Freitas S, et al. Serious gaming technology in major incident triage training: A pragmatic controlled trial. Resuscitation 2010;81:1175-9. |
| 25. | Ronicke S, Hirsch MC, Türk E, Larionov K, Tientcheu D, Wagner AD, et al. Can a decision support system accelerate rare disease diagnosis? Evaluating the potential impact of ada DX in a retrospective study. Orphanet J Rare Dis 2019;14:69. |
[Figure 1]
[Table 1], [Table 2]
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