Use of instructional technologies for medical education

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Introduction

Medical education is a continuous process, life long learning, deliberate practice (Issenberg 2005) Reaches from undergraduate study of anatomy to a call with a specialist when facing a difficult case. >Needs are multiple and reach for quick, just-in time access to content (text or pictures) to sophisticated "fly-through" Virtual Reality systems inspired by military. This page is meant to give an overview....

Challenges in medical education

Like in other fields, there is an exponential growth of knowledge of the human body, its structures and functions (Issenberg 2001). Many different levels, different fields. Multiple scenarios. Advances in medical technologies cause a shift from traditional hands-on teaching towards training of computer-assisted manipulations. Advance in educational technology, along with pedagogical approaches like problem-based learning can help educators teach skills and mold attitudes (Issenberg 2001, Choules). Bedside education: change in medical practice (shorter stays in hospital, more acutely ill patients and limited instructors time) make teaching and learning more difficult.

Medical education research

Today there is lack of scientific founded and sound comparative studies on educational developments in medicine > no serious meta study about pbl application could be done for example (Issenberg 2005).Call for higher quality in medical educational research. Each medical specialty looks only at its own litterature and seldom at other research (eg anaethesiologists look at anaesthesiology litterature etc...), not to speak of research other than in the medical education field (business industry, aviation and military).“There appears to be little awareness of the substantive and methodological breadth and depth of educational science in this field”(of high-fidelity medical simulation) (Issenber 2005). The Best-Evidence Medical Education (BEME) collaboration (Harden et al in Issenberg 2005) involves individuals, unversities and organizations committed to promote evidence-based education in medicine. The goals are to produce systematic reviews of medical educational research studies, to disseminate information woorldwide to all stakeholders and to create a culture of best evidence medical education. Outcome measurement tools for computer-based educational programs integrated into a curriculum (Issenberg 2005, Huwendiek 2009) as well as evaluation tools for elearning programs (Cook 2005) and virtual patients (Leong 2003)is an active field in medical educational research.

Instructional technologies in medical education

Searching for information

Repositories, just-in time learning, latest research findings (Choules) Link to some repositories: Medline of the National Library of Medicine in the US, many search sites that help doctors search in medline: eg for Switzerland univadis tellmed.

Virtual patients

Multimedia presentations of a patient or a case ("virtual patient", Choules) Could be a video clip showing a particular symptom in image and sound, a flash animation demonstrating a cellular process, or an x-ray with comments on the findings (Choules). examples of virtual patients sites: virtual patients ranging from text only interactive case presentation to video of a consultation or a web-based patient simulation authoring tool. These presentations can be used in tutorial sessions with small groups of students working on the case.

eLearning

Interactive "virtual patients", simulation of a clinical case. Also possible for training of "attitude" basics (Choules). Computer-Aided Instruction (CAI) like interactive CD-Rom based software, useful for learning repetitively. On demand learning. There are hundreds of programs available in many areas and levels. Example of a multimedia computer system is UMedic, a curriculum of 15 patient-centered case based programs for education in cardiology.

Simulation and Virtual Reality

Harvey, a cardiology simulation dummy and teaching device is often used together with UMedic and thus combines a physical simulation of a patient presenting a blood pressure, pulses and auscultatory findings with a multimedia computer system including computer and video graphics, sound and real-time digitized videos (Issenberg 2001). Simulation in medical education reaches from role playing (real people) over physical body simulators (dummies)(Issenberg 2001) to the virtual reconstruction of a patient's organ for "fly-through" exploration (Satava 1999) or to catastrophy scenarios involving dozens of participant "victims".

The development of endoscopic surgery with surgeons working with a monitor started a new field of technical developments around the images and the haptic ("touch") quality of the instruments. Working with a monitor, the surgeon is no longer directly looking at the patient's anatomy, his actions are no longer directly moving the instruments since there is a computer-assisted translation of motion. it is the idea of "...using bits instead of atoms" (Negroponte, from Satava 1999). Imaging technologies like magnetic resonance and computer tomogram or ultrasound develop as well as computer-assisted manipulation of the surgical instruments. This allows not only extremely precise microscopic or stereotactic surgery (eg in brain surgery) but a natural consequence is that the surgeon no longer needs to be directly next to the patient (telepresence surgery).(Satava) All these developments also bring with them the possibility to transmit virtual reality, which also means practicing and learning in a safe and controled environment. One example is the PreOp endoscopic simulator (HT medical systems), allowing to practice different types of endoscopy on a dummy with monitor simulations and haptic feel of the endoscope. Another example is an anastomosis (sewing arteries or intestines together) simulator (Raibert et Al, from Satava) measuring hand position, presssure on the instruments and tearing forces on the virtual tissue.

Synchronous and asynchronous communication

Trainig like elearning can be accompanied by forums, wikis and /or blogs that allow sharing experiences in cases where there is no evidence-based information readily available. Specialists advice just in time by phone, blogs while using an elearning course.(Choules)

Formative assessment, evaluation

All simulation and virtual reality technologies have an inherent potential for use as certification or evaluation (Satava). Simulation technologies are used in many different fields from flight simulators to managment games, nuclear plant personnel or military training and there is a growing body of evidence that simulation technology is an effective mechanism for education and evaluation (Tekian et al 1999, from Issenberg 2005). In the medical field, they

• program learner-specific findings, conditions and scenarios
• provide standardizes experiences for all examinees
• include outcome measures that yield reliable data

(Issenberg 2005)

e-portfolios for formative assessment (see the Learning e-portfolio page)(Choules) Virtual Patients can be use for examinations (Choules). MCQ, virtual patients for summative assessment. One difficulty in medicine are the multiple correct scenario(Choules)

Pedagogical scenarios

In medical education and specially during the medical sudies, the technologies described above are most effective when purposefully integrated into a curriculum. Existing web-based scenarios cover fields like patient care modules, residents educational modules for anaesthesiology, surgery (including simulations), cardiology (including patient simulators)and others. These programs must follow instructional design principles.(Petrusa 1999). An example of a pedagogical scenario is the implementation of a four-year multimedia cardiology computer curriculum at six US medical schools (Petrusa 1999). Integration into a curriculum is one of the essential features for effective use of simulations (Issenberg 2005) and other multimedia computer-based educational programs. It also allows in context evaluation of the effectiveness of the program. Outcome measurement of integrated computer-based curricula is one of the developing research fields (Petrusa, Issenberg 2005)

References

Choules, A.P., 2007, The use of elearning in medical education: a review of the current situation.

Issenberg B.S.,Gordon M.S., 2001, Simulation and new learning technologies.

Issenberg B.S., 2005, Features and uses of high-fidelita medical simulations that lead to effective learning: a BEME systematic review.

Petrusa E.R:, Issenberg B.S., 1999, Implementation of a four-year multimedia computer curriculum in cardiology at six medical schools.

Satava, R.M., 1999, Emerging technologies for surgery in the 21st century.

UMedic, a multimedia computer curriculum for cardiology, is a patient-centered system teaching patient histories, laboratory data and treatment. Can be used in combination with Harvey.

ivimed, the international Virtual Medical School, lead by numerous Universities (UK, Canada, USA, Finland...), and offering IMS and authoring tool, eg with virtual patient functions.

Harvey, the cardiology patient simulator.

Visible human project, the complete, anatomically detailed, three-dimensional representations of the normal male and female human bodies.