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

1
E-Learning Is it an effective learning modality
for clinical years of Medical Education?

• Asad J. Raja MBBS MHSc FRCS
• Professor of Surgery
• King Khalid University
• Saudi Arabia

2
IMRAD

• Introduction/Background
• Material Methods
• Results
• Discussion Conclusion

3
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 179257-259.
• Leung WC. Competency based medical training
  review. BMJ. 2002 325693-696.

4
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

5
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.
  2001357792-796.
• Masie E. Blended learning the magic is in the
  mix. In Rossett A, ed. The E-Learning Handbook.
  New York McGraw-Hill 200258-63.

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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. 199671221-226.
• 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 2000410-442.
• Clark D. Psychological myths in e-learning. Med
  Teach. 200224598-604.

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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

8
Questionnaire based Study

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

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Material Method

• Study Population
• Surgery 3 Course 473, Class of 2010, 6th
  Year Class (15), College of Medicine, KKU
• Sample Size
• Total 140 - Boys 102 Girls 38
• Study 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

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• RESULTS

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Response Rate

• Surgery 3 Course - 473Class of 2010
• Total Students 140
• Boys 102
• Girls 38
• Boys response rate 90/102 88
• Girls response rate 34/38 90

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Internet Access

• Do you have internet access at home?
• Boys n 90 Girls n 34
• 67 Yes 71 Yes
• 33 No 26 No
• 3 NR
• Around 1/3 did not have access at home

13
Internet Use

• Are you a regular internet user?
• Boys n 90 Girls n 34
• 62 Yes 71 No
• 38 No 26 Yes

14
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

15
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 34
• 22 Yes 6 Yes
• 78 No 91 No

16
E-learning Facilities Support

• How would you rate the e-learning facilities
  (enough computers, internet access, support etc)?
  
• Boys n 90 Girls n 34
• Excellent 11 6
• Good 29 24
• Average 43 26
• Poor 17 41

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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

18
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 34
• 64Yes 56 Yes
• 36No 31 No

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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 34
• Excellent 9 3
• Good 40 29
• Average 41 59
• Poor 9 6

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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

21
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 34
• Strongly Agree 17 0
• Agree 46 65
• Neither Agree/Disagree 27 18
• Disagree
  8 15
• Strongly Disagree 3 0

22
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

23
Access of kku.edu.sa

• How would you rate your experience with access
  of kku.edu.sa website?
• Boys n 90 Girls n
  34
• Excellent 14 12
• Good 40 29
• Average 33 44
• Poor 12 12

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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

25
Course Information Provided on Black Board

• How would you rate the course information
  provided to you on Black Board?
• Boys n 90 Girls n 34
• Excellent 18
  24
• Good 39 41
• Average 29
  24
• Poor 12 5
• NR 2
  6

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Postings of Quizzes

• How would you rate the quizzes posted regularly?
• Boys n 90 Girls n 34
• Excellent 27 26
• Good 39 47
• Average 23 21
• Poor 11 3

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Discussion Forum Postings

• How would you rate the Discussion Forum on Black
  Board?
• Boys n90 Girls n34
• Excellent 22 18
• Good 37 44
• Average 23
  26
• Poor 18 9

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Tegrity Sessions

• How would you rate the experience with
  recorded Tegrity Sessions?
• Boys n90 Girls
  n34
• Excellent 10
  3
• Good 34 30
• Average 31
  41
• Poor 24 23

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Skills Development Video Links

• How would you rate the experience with skills
  development video links provided to you?
• Boys n90 Girls
  n34
• Excellent 22 32
• Good 38 41
• Average 32 15
• Poor 8
  9

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Email Communication

• Did you find group email useful as a
  communication tool between instructor and your
  class fellows?
• Boys 90/102 Girls 34/38
• 61 Yes 53 Yes
• 38 No 47 No

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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 with
• little 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
  

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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

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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

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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,

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Instructor ExperienceFrom Asad J. RajaSent
Fri 5/7/2010 1006 PMTo k.mohanna_at_ekku.edu.saSu
bject 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

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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 studentsbarriers and their
  solutions. A systematic review of the literature
  Health Information and Libraries Journal
  200922(Suppl. 2)2032

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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

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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

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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

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• Thank you