E-Learning: Is it an effective learning modality for clinical years of Medical Education?

Asad J. Raja MBBS MHSc FRCSProfessor of Surgery

King Khalid University

Saudi Arabia

IMRAD

Introduction/Background Material & Methods Results Discussion & Conclusion

Introduction Medical educators are facing immense challenges today Over stretched faculty with diverse commitments Shifting of emphasis from acute care to community-based

settings Difficult to accommodate emerging “new” fields Change from traditional instructor-centered teaching to a

learner-centered model New competency-based curricula emphasize on learning

outcomes and not on the process of education Ozuah PO. Undergraduate medical education: thoughts on future challenges. BMC Med Educ. 2002; 2: 8-10.

Nair BR, Finucane PM. Reforming medical education to enhance the management of chronic disease. Med J Aust. 2003; 179:257-259.

Leung WC. Competency based medical training: review. BMJ. 2002; 325:693-696.

Pedagogical Challenges Traditional Model is teacher-centered method - rote

learning and memorization – top down – external – coercion

Progressive/Modern/Alternative Model is learner centered with real-world experiences and learner driven – internal – with slogans of "Learn by Doing" and "Learn by Discovery“

In this challenging environment e-learning offers educators a new paradigm based on adult learning theory that may result in a more effective and efficient learning experience

E-Learning E- Learning refers to the use of internet technologies to enhance

knowledge and performance and historically has two common e-learning modalities:

Distance learning, takes place at locations remote from the point of instruction

Computer-assisted instruction, (also called computer-based learning and computer-based training) uses stand-alone multimedia packages for learning and teaching

Blended learning, a fairly new term in education, is an approach that combines e-learning technology with traditional instructor-led training

Ward JP et al. Communication and information technology in medical education. Lancet. 2001;357:792-796.Masie E. Blended learning: the magic is in the mix. In: Rossett A, ed. The E-Learning Handbook. New York: McGraw-Hill;

2002:58-63.

E-Learning Advantages Active and learner-centered Learning delivery - accessibility, easy updating, personalized

instruction, distribution, standardization and accountability Learners control - content, learning sequence, pace of

learning, location and time Multimedia menu - accommodate diverse learning styles

and objectives Automated tracking and reporting Learner assessment

Chodorow S. Educators must take the electronic revolution seriously. Acad Med. 1996;71:221-226.Gibbons A et al. Computer-based instruction. In: Tobias S, Fletcher J, eds. Training & Retraining: A Handbook

for Business, Industry, Government, and the Military. New York: Macmillan Reference USA; 2000:410-442.Clark D. Psychological myths in e-learning. Med Teach. 2002;24:598-604.

Designing and Experience Blended E-Learning Course

A Blended surgery course (70% + 30%) for final year class was developed on LMS of BB

LMS was supported by Tegrity; Question Mark; Elluminate; YouTube; and links accessible to collaborating Medical School

Course details were available to the students before the start Electronic Communication only Regular Group emailing; Discussion Board; and Quizzes Student activity and tracking In the end a Questionnaire based on line survey

Questionnaire based Study

Design: BB based electronic Questionnaire SurveyObjectives: Determine students access to electronic resources Understand their perspective about e-learning Document their experience with e-learning Document barriers/suggestions from e-learners

Material & MethodStudy Population: Surgery 3 Course – 473, Class of 2010, 6th Year Class (1+5), College of

Medicine, KKU Sample Size: Total 140 - Boys 102 & Girls 38Study Period:

May 1 - June 30, 2010 (8 weeks)Study Design:

An electronic questionnaire based survey was conducted at the end of 8 weeks Course. Twenty five questions were framed as Either/Or; Opinion Scale/Likert; and Short Answers/Qualitative

RESULTS

Response Rate Surgery 3 Course - 473

Class of 2010

Total Students: 140Boys: 102Girls: 38

Boys response rate: 90/102 = 88%Girls response rate: 34/38 = 90%

Internet Access

Do you have internet access at home? Boys n = 90 Girls n = 34

67% Yes 71% Yes33% No 26% No

3% NR

Around 1/3 did not have access at home

Internet Use

Are you a regular internet user?Boys n = 90 Girls n = 3462% Yes 71% No38% No 26% Yes

Wi-Fi Access at KKU/ACH

Did you get access to wireless internet anywhere in the KKU boys campus or in the

Girls Teaching building at Aseer Central Hospital?

Boys n = 90 Girls n = 34 84% No 93% No 16%% Yes 7% Yes

Access to Computer Labs

Did you have access to computer labs at KKU boys campus or at Girls Teaching building at

Asser Central Hospital?

Boys n = 90 Girls n = 3422% Yes 6% Yes 78% No 91% No

E-learning Facilities & Support

How would you rate the e-learning facilities (enough computers, internet access, support etc)?

Boys n = 90 Girls n = 34Excellent 11% 6%Good 29% 24%Average 43% 26%Poor 17% 41%

Define E- learning

Majority correctly defined it and knew its strengths and limitations

They were all clear that it should compliment and not replace traditional teaching

Majority were critical that it takes away the teacher student contact

Only beneficial if internet resources, support system and time available; waste of time as not ready yet; difficult and weak learning modality; lot of limitations; average; should never replace the traditional model

Acceptance of e-learning

Do you think necessary change has occurred at the university in terms of acceptance of e-

learning? Boys n = 90 Girls n = 3464%Yes 56% Yes 36%No 31% No

Learning Style and Needs

Every one has their own learning style. How well does e-learning support your learning

style and needs?Boys n =90 Girls n =34Excellent 9% 3%Good 40% 29%Average 41% 59%Poor 9% 6%

E-learning is time effective

Do you think e-learning is time effective i.e. do you learn effectively and in shortest possible

time? Boys n =90 Girls n =34

50% Yes 29% Yes 50% No 68% No

E-learning – user friendly

Do you think e-learning resources i.e. Black Board, Tegrity and other components within the programs are

user friendly?

Boys n =90 Girls n =34Strongly Agree 17% 0%Agree 46% 65%Neither Agree/Disagree 27% 18%Disagree 8% 15%Strongly Disagree 3% 0%

E-Learning Skills Training

How would you rate the e-learning skills training provided to you at the start of the

course? Boys n = 90 Girls n = 34

Excellent 16% 9%Good 42% 35%Average 31% 41%Poor 11% 12%

Access of kku.edu.sa

How would you rate your experience with access of kku.edu.sa website?

Boys n = 90 Girls n = 34Excellent 14% 12%Good 40% 29%Average 33% 44%Poor 12% 12%

Preference of Learning Style

What learning style would you prefer? Boys n =90 Girls n =34

Traditional Learning 27% 41%E – Learning 12% 3%Blended 61% 53%

Course Information Provided on Black Board

How would you rate the course information provided to you on Black Board?

Boys n =90 Girls n =34Excellent 18% 24%Good 39% 41%Average 29% 24%Poor 12% 5%NR 2% 6%

Postings of Quizzes

How would you rate the quizzes posted regularly?

Boys n =90 Girls n =34Excellent 27% 26%Good 39% 47%Average 23% 21%Poor 11% 3%

Discussion Forum Postings

How would you rate the Discussion Forum on Black Board?

Boys n=90 Girls n=34Excellent 22% 18%Good 37% 44%Average 23% 26%Poor 18% 9%

Tegrity Sessions How would you rate the experience with

recorded Tegrity Sessions? Boys n=90 Girls n=34

Excellent 10% 3%Good 34% 30%Average 31% 41%Poor 24% 23%

Skills Development Video Links

How would you rate the experience with skills development video links provided to you?

Boys n=90 Girls n=34Excellent 22% 32%Good 38% 41%Average 32% 15%Poor 8% 9%

Email Communication

Did you find group email useful as a communication tool between instructor and

your class fellows?

Boys 90/102 Girls 34/3861% Yes 53% Yes38% No 47% No

Barriers to E-Learning (Boys) NR 17; 10 No barriers; 6 cost issues as expensive 52 - Accessibility issues; problems of KKU website; and

speed 17 - would prefer traditional teaching as teacher student

interaction essential and better; time consuming withlittle benefit

11 - poor computer literacy; slow typing speed; no training programs; wasted lot of time; no motivation

3 - wanted subsidized laptops and internet connections; separate computer lab for medical college; Wi-Fi availability all over campus

2 – found BB boring and wanted the get up changed

Barriers to E-Learning(Girls)

NR - 8; 5 - cost issues as expensive 22- Accessibility issues; problems of KKU website; and

speed; access at home and ACH not at all possible 18 – Very time consuming; lot of effort without benefit 5 – want traditional teaching as it takes away the

student teacher interaction 5 – Besides teething problems it is a good learning

source for the future; exciting & useful if everything worked well; easy and good but not used to it; not good for clinical side as we need to be with patients; needs improvement

4 – Many faculty members did not support e-learning and discouraged students; neither students nor doctors are used to such a modality of learning

E- Learning Component of Surgery 3 Course

Did you enjoy the e-learning component of your Surgery 3 course?

Yes 55% 65%No 45% 35%

Instructor Experience The courses organized for faculty were excellent and

very informative with hands on training Whole faculty in e-learning deanship is just excellent

and very cooperative Their eagerness and endless desire to help is

commendable – ‘they really know what they are doing’ Mr. Feras; Dr. Khaled Mohanna; Ms. Mariam Awaji,

Instructor ExperienceFrom: Asad J. RajaSent: Fri 5/7/2010 10:06 PMTo: k.mohanna@ekku.edu.saSubject: Surgery - 3 Course and E - learning experience

Technical Issues between e-learning Deanship and KKU Server -reliability

Access –Wi-Fi issues at KKU; need for more labs in different colleges in KKU; access at Aseer Central Hospital; Labs compatible for examinations

Availability of skills development tools; support for development of interactive sessions

Tegrity is crucial – slow speed; only 500MB space = +/- 5 lectures Question Mark/Question Bank Course access to all faculty and not just Course Coordinator Permanent repository and access to course

DISCUSSION

The main barriers identified 57 studies reviewed: requirement for change; costs; poorly designed packages; inadequate technology; lack of skills; need for a component of face to-face teaching; time intensive nature of e-learning; computer anxiety

A range of solutions can solve these barriers. The main solutions are: standardization; strategies; funding; integration of e-learning into the curriculum; blended teaching; user friendly packages; access to technology; skills training; support; third party paying e-learning costs; dedicated work time for e-learning

Childs et al. Effective e-learning for health professionals and students—barriers and their solutions. A systematic review of the literature Health Information and Libraries Journal 2009;22(Suppl. 2):20–32

CONCLUSION Developments in e-learning and technologies are creating the

groundwork for a revolution in education Individualized learning (adaptive learning), interactions with

each other (collaborative learning), and transforming the role of the teacher from distributors of content to facilitators of learning and assessors of competency

The integration of e-learning into UG, PG & CME promotes a shift toward adult learning in medical education – Self Directed Learning

CONCLUSION (contd.)Is e-learning an effective learning modality for clinical years of Medical Education?

E-learning for clinical medical education will always be blended and an excellent tool

Clinical component will mostly remain f2f but lectures can certainly be done much better through e-learning. Skills lab will also become obsolete as it is better done through video technology – 3D

There may be technical problems, access issues and training & development issues – internal teething problems -nothing to do with e-learning

FINALE

E- learning is a revolution and a reality and very much here to stay. We need to

innovate, exploit & harness this technology in order to compliment &

enhance learning to improve our standards of education

Thank you