E-learning in Gerontology and Geriatric Education

1. E-learning in Gerontology and Geriatric Education Jorge G. Ruiz, MD, FACP Associate Director for Education/Evaluation, VA GRECC, University of Miami Miller School of Medicine and Stein Gerontological Institute Miami, Florida

2. E-learning in Gerontology and Geriatric Education - Objectives • To discuss the rationale for the use of e-learning and the educational theories, principles, or features that should be considered when developing effective e-learning • To recognize the most significant gaps in the e-learning literature • To discuss the role of e-learning in scholarship • To describe some e-learning initiatives in gerontology and geriatric education

3. Advances in Geriatric E-learningGeriatrics Education • Definitions and Classification • Rationale • Indications • Geriatric E-learning • Research • Virtual Patients in geriatrics

4. Definitions and Classification

5. Definition • E-learning refers to the use of Internet technologies to deliver a broad array of solutions that enhance knowledge and performance • Web-based learning, online learning, distributed learning, computer-assisted instruction, or Internet-based learning. • Multimedia E-learning: the use of words and pictures in e-learning Rosenberg M. E-Learning: Strategies for Delivering Knowledge in the Digital Age. New York: McGraw-Hill, 2001.

6. Methodologies Tutorials Simulations – animations to virtual patients Hypermedia-Hypertext Games Computer-based assessment-practice Collaborative learning (blogs, wikis) Access & Management Portals Databases, repositories LMS Search engines ePortfolios Delivery CBT, recording media, networks, PDA, eBooks, broadcasting media Classification

7. Rationale

8. Why E-learning? • Effective – at least as good as traditional instruction (multimedia e-learning?) • Efficient – Obvious • Cost-effective - may be • Accessible – definitely • Deliberate Practice Chumley-Jones HS, Dobbie A, Alford CL. Web-based learning: sound educational method or hype? A review of the evaluation literature. Acad Med. 2002;77(10 Suppl):S86-93.

9. Deliberate Practice • The repeated performance of a particular task where feedback on performance is available and the purpose is to improve performance • Geriatrics: Seeing lots of patients • Case-mix: May not be possible • E-learning approaches may offer alternatives for the acquisition of expertise Ericsson, K.A., Krampe, & Tesch-Romer. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100(3). pp. 363-406

10. Cognitive Learning Framework • Predominant framework: Many theories? • Explain how the brain processes and stores new information • Working memory: limited • Long-term memory: virtually unlimited • A growing body of empirical evidence • Theories: • Dual-coding theory • Cognitive Theory of Multimedia Learning

11. Cognitive Theory of Multimedia Learning • Principle: Words + Pictures = better learning • Dual-channel • Limited capacity • Active processing (selection, organization, integration)

12. Percent Correct on Problem Solving Mayer RE, Anderson R. Animations Need Narrations: An Experimental Test of a Dual-Coding Hypothesis. Journal of Educational Psychology. 1991;83:484-490.

13. Percent Correct on Problem Solving Mayer RE, Anderson R. Animations Need Narrations: An Experimental Test of a Dual-Coding Hypothesis. Journal of Educational Psychology. 1991;83:484-490.

14. Indications

15. Curriculum DevelopmentKern 6 Steps: • Problem identification and general needs assessment • Needs assessment for targeted learners • Goals and objectives (competencies) • Educational Strategy = e-learning? • Implementation • Assessment and Evaluation

16. Indications • Instructional gaps (competencies): • Attitudes: Evidence for motivation • Knowledge: Efficient • Skills: It depends • Psychomotor • Social • Clinical Reasoning • What is the critical skill?

17. Critical Skills (Norman)

18. Matsumoto 2002 Matsumoto ED, Hamstra SJ, Radomski SB, Cusimano MD. The effect of bench model fidelity on endourological skills: a randomized controlled study. J Urol. 2002;167(3):1243-7.

19. Matsumoto 2002 Matsumoto ED, Hamstra SJ, Radomski SB, Cusimano MD. The effect of bench model fidelity on endourological skills: a randomized controlled study. J Urol. 2002;167(3):1243-7.

20. Geriatric E-learning Content Animation Virtual Patients Animations Simulation-Game Tutorials

21. Computer-based testing Wiki Blog Digital Video Geriatric E-learning Content

22. Geriatric E-learning Access GEC Clearinghouse AAMC MedEdPORTAL Family Medicine Digital Resources Library CELGI

23. Geriatric E-learning Access GRECC audioconferences LTC GeriU Florida The GeriatricWeb POGOe

24. Educational Scholarship • AAMC MedEdPortal: Peer Review • AAMC Seal • Letter to your Dean • JAGS Education & Training Section • Educational Resources Column • JAGS Citation • Employee Education Innovation Grant Announcement

25. Research

26. AAMC 2006 Colloquium Findings • Educational technology is widely used in medical education & has many advantages • The current evidence base is anemic • There are research-based guidelines for multimedia and human-patient simulation • We should not ask “Does it work?” but rather, “How and when is it most effective?” From Chris Candler MD presentation during the MedBiq 2007 meeting in Baltimore

27. Comparative ET research • Avoid media comparatives studies • Can be controlled (minimize confounding) • Help us know how to use, improve the new technology (clarification) • Quantitative studies: RCT or quasi-experimental, surveys, systematic reviews • Qualitative studies • Data collection: focus groups, interviews, observation • Data analysis: thematic, grounded theory

28. Key questions for future research – When to? • Replace or augment existing course? • Use specific modalities? • facilitate learning in clinical practice (just-in-time learning)? • Use group vs. individual work? • Use real pt vs. simulation? • Use mandatory vs. optional? • Get instructors to have additional training? • Use in postgraduate training / CME? From David Cook, MD presentation The Research Agenda: The failure of research in educational technology to inform practice, and what we can do about it. MedBiq 2007 Annual Meeting

29. Key questions for future research - How to? • to teach effectively? • Cog. process method  design • to match design to objectives? • to effectively use multimedia and fidelity? • can e-learning courses be individualized? • (adaptation vs. autonomy) • can design be automated? • do we assess learning? From David Cook, MD presentation The Research Agenda: The failure of research in educational technology to inform practice, and what we can do about it. MedBiq 2007 Annual Meeting

30. Key questions for future research Matching method to Critical Skill ? From David Cook, MD presentation The Research Agenda: The failure of research in educational technology to inform practice, and what we can do about it. MedBiq 2007 Annual Meeting

31. GeriVIP: Geriatrics Virtual Patient Aims • To collaboratively develop geriatric virtual patients to address key content and competency areas in geriatric education. • To share geriatric virtual patient as part of a VP “bank” • To investigate the effectiveness, efficacy and efficiency of virtual patients in geriatric education

32. Problem identification Needs Assessment of Target learners Goals and objectives: Competencies Educational Strategy Implementation Assessment and Evaluation Geri VIP: Virtual Patients Chronic pain in the elderly Internal medicine residents The resident will assess and manage chronic pain in older outpatients with chronic conditions Virtual Patients Primary Care blended e-learning curriculum Assessment: Chart Review, script concordance test, clinical vignettes Evaluation: Effectiveness, efficiency, feasibility, features

33. GeriVIP: Geriatrics Virtual Patient Project Authoring tool • WebSP (Karolinska) Initial Themes • Geriatric pharmacology, chronic pain, patient safety Geriatrics and Gerontology Educators • Author, Content Expert, Reviewers, Contributors What institutions get: • Access to bank of virtual patients • Assistance with submission of VPs to MedEdPORTAL • Participation in VP multi-institutional research

34. Conclusions • E-learning: effective, efficient, accessible • Deliberate practice especially relevant • Cognitive psychology-learning basis • Accumulating evidence-base • Geriatrics E-learning: content and access • Research: Wide open – when and how to use e-learning in geriatrics education • Virtual patients: Research & Education opportunities for collaboration

35. Gerontology and Geriatrics Web Sites • LTC GeriU: http://ltc.geriu.org • POGOe: http://www.pogoe.org • CELGI: http://www.celgi.org • GeriatricWeb: http://geriatricweb.sc.edu/ • GRECC Audioconferences: http://www.pogoe.org/GRECC • MedEdPORTAL: http://www.aamc.org/mededportal • GEC Clearinghouse: http://www.nagec.org/resources/ • FMDRL: http://www.fmdrl.org/ • HEAL: http://www.healcentral.org/