Online learning inpaediatrics: a student-led web-based learningmodalityPeter Gill, Lauren Kitney, Daniel Kozan and Melanie Lewis, Department of Paediatrics,University of Alberta, Edmonton, Canada

SUMMARYBackground: Undergraduatemedical education is shiftingaway from traditional didacticmethods towards a more self-directed learning environment.E-learning has emerged as a vitallearning modality that allowsstudents to apply key principlesto practical scenarios in a trulypersonalised approach.Context: At the University ofAlberta, paediatrics is taughtlongitudinally, with lectures dis-tributed throughout the preclini-cal curriculum and concentratedin the 8-week paediatric clinicalclerkship. As a result, studentsentering clerkship lack core foun-dational knowledge and clinicalskills.

Innovation: PedsCases(http: ⁄ ⁄ www.pedscases.com) is astudent-driven interactive websitedesigned to achieve the learningoutcomes identified by thecompetency-based paediatriccurriculum. This open-accesse-learning tool is a comprehensivepeer-reviewed learning resourcethat incorporates various learningmodalities. Material is studentgenerated and peer reviewed bystaff paediatricians to ensurevalidity, accuracy and usefulness.After 17 months, PedsCases con-tains 216 questions, 19 cases, 11flashcard-type quizzes, 11 pod-casts and two clinical videos, andhas had 2148 unique visitors from73 different countries. PedsCasesis one of the top five references

returned by Internet search en-gines for the phrase ‘paediatricsfor medical students’.Implications: PedsCases is a col-laborative resource created forand by medical students thatprovides an opportunity for activeself-directed learning while dis-seminating knowledge in an evi-dence-based, interactive andclinically relevant fashion. Peds-Cases encourages students to takean active role in their educationand drive medical education ini-tiatives in response to the evolv-ing curriculum. As the focus ofmedical education shifts towardsindependent learning, student-led educational tools such asPedsCases have emerged asessential resources for students.

E-learning hasemerged as avital learningmodality

Developingknowledge

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BACKGROUND

Undergraduate medical edu-cation is shifting awayfrom traditional didactic

methods towards a more self-directed learning environment.1

This emphasises active inquisi-tion, clinical reasoning andproblem solving skills, whileteaching students to becomelifelong learners.2 E-learning hasemerged as a vital learningmodality that allows students toapply key principles to practicalscenarios in a truly personalisedapproach.3,4 The increasingimportance of e-learning isreflected by the creation ofrepositories to manage thegrowing number of resources,such as the Association ofAmerican Medical Colleges(AAMC) MedEdPORTAL.5

At the University of Alberta,paediatrics is taught longitudi-nally, with lectures sparselydistributed throughout thepreclinical curriculum, and con-centrated in the 8-week paediat-ric clinical clerkship. As a result,students entering clerkship lackcore foundational knowledge andclinical skills. This precipitatedthe student-led creation of aneducational tool to focus on thecore objectives of paediatriceducation.

PedsCases (http: ⁄ ⁄ www.peds-cases.com) is a student-driveninteractive website designed tomeet the learning objectivesoutlined for paediatric under-graduate medical education. Thisopen access e-learning tool is acomprehensive peer-reviewedlearning resource that incorpo-rates questions, multi-step cases,flashcard-type quizzes, podcasts,clinical videos and links to clin-ical practice guidelines. Thisarticle outlines our institution’sexperience with creating thise-learning tool, its integrationinto the undergraduate medicaleducation curriculum and futuredirections.

DEVELOPMENT OFPEDSCASES

PedsCases was developed and en-hanced using the open-sourceprogramming framework RUBY onRAILS

� by a medical student at theUniversity of Alberta. It utilisesWeb 2.0 technologies, and con-tains tools to sort and refine thematerial based on quality andrelevance. Detailed data on siteusage is collected by GoogleAnalytics (http: ⁄ ⁄ www.google.com ⁄ analytics).

PedsCases is a free and en-tirely student-driven initiative.The premise of the website is that

students create the material di-rected towards core paediatriclearning outcomes, listed inBox 1, but paediatricians peerreview the material to ensurevalidity, accuracy and usefulness.Figure 1 outlines the process ofmaterial creation. With eachobjective, the creation of multiplelearning modalities is encour-aged, in the form of cases, pod-casts, questions, conditions andvideos.

Each submitted item is ‘tagged’or labelled with one or more of thetopics listed, encompassing thediversity of paediatric subspecial-ties. Each subspecialty home page

Box 1. Core paediatric learning outcomes for medicalstudents

Students should be able to demonstrate an approach to the followingpaediatric presentations before they exit medical school:

• Child abuse

• Altered level of consciousness

• Seizures

• Fluid and electrolyte abnormality

• Fever

• Newborn infant

• Health supervision

• Developmental and behavioral problems, and mental health

• Growth

• Respiratory distress ⁄ cough

• Heart murmur

• Abdominal pain

• Diarrhoea

• Vomiting

• Jaundice

• Rash

• Anaemia

• Proteinuria ⁄ haematuria

• Limp

Students should be able to demonstrate experience with the followingprocedures (A, attempt; M, mastery; O, observe; S, simulation):

• Otoscopy (M)

• Throat Swab (M)

• Intravenous (IV) initiation (O ⁄ A ⁄ S)

• Lumbar puncture (O ⁄ A ⁄ S)

The increasingimportance of

e-learning isreflected by the

creation ofrepositories

54 � Blackwell Publishing Ltd 2010. THE CLINICAL TEACHER 2010; 7: 53–57

has a ‘moderator’ or subspecialtypaediatrician who must approvethe tagged content in order formaterial to appear in the respec-tive section. For example, a ques-tion on otitis media would belabelled with ‘General Paediatrics’and ‘Infectious Disease’. Modera-tors receive daily e-mails notifyingthem of new content that requiresapproval and revision.

When developing multi-stepclinical cases, podcasts and vid-eos, students contact paediatri-cians directly to discuss thepotential learning tool. Figure 2outlines the process of creatinga podcast. The podcasts areavailable online at iTunes(http: ⁄ ⁄ www.apple.com ⁄ itunes)and the videos are hosted onYouTube (http: ⁄ ⁄ www.youtube.com), at no cost to the user.

The final learning modality is aflashcard-type recall quiz called

‘Conditions’. Students can createcondition-specific pages in theformat of a recall quiz, where thesite user reads the question andslides the cursor over the ‘show’

icon to reveal the answer. Thecondition page lists the top-10search results from the TurningResearch into Practice (TRIP)database, and allows students toaccess evidence-based articlesabout the particular condition.

INTEGRATION INTOCURRICULUM

PedsCases is embedded into theundergraduate paediatric medicaleducation curriculum at the Uni-versity of Alberta. It is one of themain resources recommended tostudents to cover the core objec-tives of the clinical paediatricrotation, and to assist in prepar-ing for the final examinations. Inaddition, lecturers in the preclin-ical curriculum may refer studentsto PedsCases to supplementdidactic lectures.

The podcasts are widely dis-tributed and students areencouraged to utilise them as asupplement to lecture material.The University of Alberta has anIntegrated Community Clerkship(ICC) programme, in which acohort of medical students spendsan 8-month block in a rural com-munity via a distributed medicaleducation model. PedsCases istaking on a growing role inadministering high-quality

Published

Accept

Labeled with respective topic on PedsCases

Review

Subspecialty moderators peer review material and provide feedback

Label

“Tag” content with up to 32 different topics

Explain

Write an explanation, post a link or cite article for further information

Create

Write question, multi-step case or flashcard type quiz

Register

Free sign up to PedsCases with a valid email address

Objective

Select topic from list of undergraduate paediatric objectives

Identify Topic

Figure 1. Flow chart outlining the content creation process for PedsCases.

Figure 2. Steps in the creation of a PedsCases podcast.

Studentscontactpaediatriciansdirectly todiscuss thepotentiallearning tool

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paediatric education via distrib-uted learning.

EFFECTIVENESS OF THELEARNING MODALITY

Currently, a study enrolling allthird-year medical students at theUniversity of Alberta in the2009 ⁄ 2010 academic year isongoing. The objective is toevaluate the effectiveness ofPedsCases for students studyingpaediatrics in both urban andrural settings. All learningmodules developed for PedsCases,including cases, podcasts andvideos, are being submitted to theAAMC’s MedEdPORTAL to undergoadditional peer revision.

At the time of submission,PedsCases contains 216 ques-tions, 19 cases, 11 flashcard-typequizzes, 11 podcasts and twoclinical videos. There are 32 sub-specialty pages, with 15 activelymoderated by one or more paedi-atricians. There are 15 paediatri-cians involved in PedsCases invarious capacities, as moderators,peer reviewers, case writers, pod-cast writers, etc. In addition,there are seven students activelygenerating content in the form ofpodcasts, cases and questions. Asa result of the success of Peds-

Cases, the Department of Paedi-atrics funded two summer studentpositions during the summer of2009 to focus on site develop-ment.

The number of visitors toPedsCases has grown steadilysince its inception in spring2008. After 17 months, therehave been 23 521 page viewsfrom 2148 unique visitors in 73different countries. PedsCases isone of the top five referencesreturned by internet searchengines (including Google andYahoo!) for the term ‘paediatricsfor medical students’. It is listedas a recommended resource atseveral institutions and organi-sations, such as the CanadianHealthcare Education Commons(CHEC).

DISCUSSION

PedsCases is a student-generatedinteractive website designed toaid medical students in learningpaediatrics. PedsCases encouragesstudents to take an active role intheir education and drive medicaleducation initiatives in responseto the evolving curriculum. Thewebsite is created for and bymedical students, and providesthe opportunity for active self-

directed, student-centred learn-ing in paediatrics.

Since the creation of Peds-Cases, students have been ex-posed to core paediatric topicsearlier in their medical training.Students can independentlysearch for knowledge withoutwaiting for a lecture on the par-ticular topic by listening to ashort 10–15-minute podcast,working through an interactiveclinical case or completing a quizon a particular topic. Thisempowers students and infusesthem with confidence during theirclinical rotation. Furthermore,students completing subspecialtyelectives can prepare by reviewingthe database of core questions,cases, podcasts and links tokey articles specific to the sub-specialty.

In preparation for the paedi-atric clerkship exam and objectivestructured clinical examination(OSCE), PedsCases offers adatabase of excellent exam-likequestions to prepare students.The focus on creating short,concise and clear podcastsensures students are able toreview the key objectives ofseveral topics in an efficientmanner. There is a documentedspike in site usage during theweek preceding the paediatricclerkship exam.

Students completing theirclerkship in the rural ICCprogramme, distributed overseveral rural sites, now haveaccess to the same high-qualityand objective-learning resourcesas students in the city. Thisallows students to ensure theyare learning the same coreobjectives and competencies astheir peers.

By challenging students topersonalise their own learningand to contribute to the learningof others, in addition to inte-grating evidence-based medicine,PedsCases aims to bridge the gap

Picture 2. Listening to podcast – PedsCases.

Students havebeen exposed tocore paediatric

topics earlier intheir medical

training

56 � Blackwell Publishing Ltd 2010. THE CLINICAL TEACHER 2010; 7: 53–57

between theory and practice in asafe but realistic environment.PedsCases provides an avenue forstudents to work directly withfaculty paediatricians. It providespaediatricians an opportunity toreceive feedback on lectures,concepts and misconceptions.They can step forward and assistin creating high-quality material,working collaboratively withstudents.

LIMITATIONS

PedsCases is continually growingand expanding to address theneeds identified by medical stu-dents. However, it is currently notadequate to form the sole refer-ence material for medical stu-dents. The large volume ofknowledge required in paediatricscreates a significant challenge todevelop a resource that is all-encompassing.

FUTURE DIRECTION OFPEDSCASES

As PedsCases grows, there will befurther development of resourcesto ensure all core objectives arecovered. In addition, studentsand staff will continually berecruited from both the Universityof Alberta and other institutions.

All materials created will besubmitted to the AAMC’s MedEd-PORTAL for additional peer re-view. The completion of theresearch study will evaluate theeffectiveness of PedsCases as alearning modality for undergrad-uate medical students at theUniversity of Alberta.

CONCLUSION

PedsCases has been integratedinto the third-year undergraduatepaediatric medical education

curriculum at the University ofAlberta. It is one of the mainresources recommended tostudents to cover the coreobjectives of the clinical paedi-atric rotation, and to assist inpreparing for the finalexaminations.

PedsCases is a collaborativeresource created for and by med-ical students that provides anopportunity for active self-direc-ted learning. As the focus ofmedical education shiftstowards independent learning,student-led educational toolssuch as PedsCases have emergedas essential resources forstudents.

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Picture 3. Staff and student collaboration – PedsCases.

Students… inthe rural ICCprogramme…now have accessto the samehigh-qualityand objective-learningresources

Corresponding author’s contact details: Peter Gill, 1C4.24 WC Mackenzie Health Sciences Centre, 8440-112 Street, Edmonton, Alberta, Canada.E-mail: pjgill@ualberta.ca

Funding: Department of Paediatrics, University of Alberta.

Conflict of interest: None.

Ethical approval: Ethical approval was not sought for the research described. The statistics gathered are from observations of site usage

by an international gratuitous website. The work was carried out in accordance with the Declaration of Helsinki, including, but not

limited to, there being no potential harm to participants, the anonymity of participants being guaranteed and the informed consent of

participants being obtained.

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