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; 179:257-259. Leung WC. Competency based medical training: review. BMJ. 2002; 325:693-696.

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. 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.

6. 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.

7. 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

9. Material & Method Study Population: Surgery 3 Course – 473, Class of 2010, 6th Year Class (1+5), 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

10. RESULTS

11. 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%

12. 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%

17. 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 64%Yes 56% Yes 36%No 31% No

19. 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%

20. 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%

24. 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%

26. 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%

27. Discussion Forum Postings How would you rate the Discussion Forum on Black Board? Boys n=90 Girls n=34 Excellent 22% 18% Good 37% 44% Average 23% 26% Poor 18% 9%

28. 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%

29. Skills Development Video Links How would you rate the experience with skills development video links provided to you? Boys n=90 Girls n=34 Excellent 22% 32% Good 38% 41% Average 32% 15% Poor 8% 9%

30. 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

31. 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

32. 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 – Verytime 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

33. 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%

34. 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,

35. 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

36. 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

37. 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

38. 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

39. 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

40. Thank you