Wednesday, August 12, 2009


Everyone who uses a computer learns online. We learn when we Google a topic and sort and read the resulting hits. We gather new information and use it immediately (time of a movie) or reflect on it and weave it into our understanding of a new or familiar theme.

What about using online learning as the primary method for learning about medicine? Can our students, residents and fellows (as well as ourselves) effectively learn what we need to know through online classes? Numerous studies have clearly indicated that some people can learn very effectively online. Other studies indicate that the effectiveness of online learning is dependant on the subject matter, the skill of the teacher to create online learning environments, and the learning style and personal characteristics of the learner.

In response to reduced duty hours, the introduction or expansion of online or distance education classes seems to make good sense. Online CME offerings also become more attractive as travel restrictions due to the lingering recession limit CME choices.

Sometime in the next year someone is going to ask you about online learning. What do you think? Is it ready for PRIME TIME?

Should we forget about lectures and get the very best teachers to create online courses that our students and residents can access day or night?

Are there topics that can not be taught online?

Are there types of learners that you think will have problems with online learning?

If you have taken an online CME course, or taught an online course, what type of experience was it for you? If you have no experience but have an opinion, let us know. Let’s see what the collective wisdom is about integrating online learning into our medical schools and hospitals.


Steve said...

I'm not sure about Prime Time, but I think it has its place (mostly for factual information). I've taken an online course and it was ok. I missed the interaction with the class. We had a chat room, but that felt odd. I do like this BLOG and I guess it is a form of online learning,.. isn't it?

Askar said...

Interaction between the educator and the audience is a key and so long as you maintain a mechanism of effective and timely communication online learning could be very effective. I have an experience with a form of distant learning that is not necessarily online but I think has a lot in common. In our field “Histocompatibility and Immunogenetics” Georgetown University Teleconferences have been around for more than a decade. It is approved by the American Board for Histocompatibility and Immunogenetics and participants earn Continuing Education Credit. Participants can listen to the lectures in one of two ways, either live on the day of the conference, or through listening to a recording of the lecture. No doubt that there are advantages to both types of participation. Those who participate in the live conferences can ask questions and get immediate answers as well as listen to other participants’ questions and comments. Alternatively, participants who chose to listen to recorded lectures gain the flexibility of scheduling educational sessions at a time that works best for their schedule. I have participated in many of them in both formats and I will give a teleconference talk next month but still I find attending the live conferences much more effective.

Anonymous said...

I would have difficulty with online learning, as I need to be actively involved. I think this blog works for me because I know some of the individuals involved, so there is the personal connection and commitment. I think that courses that concern professionalism and communication skills would be difficult to conduct and that skills involving these competencies difficult to assess. Would like to hear from others if they have had experience with these competencies teaching them online.

Anonymous said...

I took an online CME course and it was the most painful experience of my life! All the humanity of learning together was sucked out of it. I did learn something, which would make it a success to some people, but I thought it was awful.

Anonymous said...

For CME, I typically prefer online because I can crank them out when I feel like it. BUT: (here comes the truth) I skim through the material as quickly as possible, I go straight to the test when possible and guess at the answers (especially if there is a chance to repeat the test). This is possible for CME because it is usually something that I AM keeping up with, but just need the credits for credentialling (ie, I already know the material).

When learning NEW material, I hate online because there is no interaction, no opportunity for "aha" moments.

In residency, we had a series of online modules with discussion groups for topics such as ethics, medicine in society, etc. These were so the programs could meet acceditation requirements. These modules were AWFUL. Everyone cut and pasted answers in order to get them done. We learned nothing and the institution bragged about how it used online teaching and sold the modules to other institutions to torture other residents.

Some material can be presented online - but I think we are giving online learning attributes it doesn't really have and minimizing the importance of human interaction.

g.feinberg said...

there is a place for online learning with medicine as has been posted. Replacing classroom? I don't think so. If medicine was 100% cookbook it could be, and all students could research algorythms and/or just be given PDA's and take an online class on "How to look things up". With the "ART", we need to critically think, and I don't believe you can learn that by computer. As much as technology has progressed, there is no substitute for human interaction and the human brain. (I tell my techo-students that all of their technology is great as a COMPLEMENT to their knowledge, but if used as the PRIMARY, what happens when the battery dies or the electricity goes out? They still need to rely on their God given battery...their brains)

Anonymous said...

online fits a need - the need of expediency and often cost savings - the same material can be presented again and again without personnel time; it can be utilized at times of convenience, it can provide core material that can be embellished with real people in real time for (perhaps) greater efficacy. we can make it interactive and give the impression of active learning... BUT i find that I (and per conversations with others) am multitasking and give it limited attention as i click through. i think that we are kidding ourselves in thinking it is any where close to a uniformly effective teaching tool - AND my main concern is that many institutions are using it more and more exactly because of the expediency issues - and learners are being bombarded and are now numbed to the venue. i dont think click through learning is effective learning (but good to demonstrate that requirements are being met - ie learners need to be exposed to xyz.

Doug Danforth said...

We offer a largely "on-line" version of our medical curriculum. There is some f2f but the majority of the first two years are done independently with few traditional lectures. We also offer a traditional lecture based curriculum.

The result? Independent Study Students learn life long learning skills, work at their own pace (within limits), and perform as well or better than their lecture based contemporaries on STEP 1.

If it fits your learning style, then it can be a very effective way to learn. I would argue that the traditional f2f lecture based approach, where students are passive receptacles of our wisdom and knowledge is a fairly inefficient way to teach and learn.


Deirdre said...

The first time I attended an online medical conference, I was sold on the concept because of the amount of active interaction taking place.

Online learning allows our medical college to bring in speakers for an hour that we might not have access too.

Online learning communities such as Twitter connect students to people in other countries.

My Medical Education Wiki and Blog attracts people from all over the world

mjcosta said...

The question is misleading, just as asking "should we use cars to move between any two cities". The answer is : it depends.
Online tools have their own strengths and weaknesses to assist teaching and learning just like any other tool. Technologies solve a lot all problems but never all problems. That's why they keep evolving.
I believe other questions are needed to deepen the debate. One suggestion: what are the caveats/weaknesses in teach9ing and learning of medical students can online tools help to address and how should they be used for a particular purpose?".
Manuel João Costa
University of Minho, Portugal

Craig said...

There may probably a number of reasons why online learning may or may not be "ready for prime time." One factor, in addition to differences in adult learner style may be generational differences. For example, "millenials" may feel more comfortable simply with using computers and navigating systems. In contrast, "baby boomers" many or may not have that comfort zone. As an instructor using online learning, I felt very disconnected from the learner. That is, there is a loss of visual cues from the student that can help direct the instructor one way or another. I actually felt very unsure as to whether anyone was connecting to what I was trying to teach. Visual feedback from the student is so important. It helps the instructor to modify his/her presenaton and provide further clarification, when necessary.

Neil said...

There have been numerous studies that show that "online learning" or "Computer based teaching" are at least as effective as traditional learning but are perceived as more satisfying or enjoyable by the learners. The recent meta-analysis actually showed that online learning is more effective than classroom based learning.

The problem is that we are really comparing apples and oranges. What would you say if someone asked you "is an oral pill better than a patch for treating condition X?" Not a great example but you get the idea. It depends on what the pill is and what the patch is.

We cannot lump all classroom eduation together - its effectiveness depends on so many things:
1. Interest in the topic
2. The skills/art of the educator
3. Lecture vs. small group vs. QA vs. other...

In the same way you cannot lump all online learning together. We have all experienced horrible examples of both online and classroom learning. We cannot generalize from those examples.

The key issues are that if the student is motivated and wants to learn something, s/he will learn in most cases. If people are "forced" the take lessons that they personally don't want to or don't see the need for, then learning is likely to fail.

If a studnet is given an hour to do an online course and cannot do anything else during that time, (analogous to many classroom situations), then a well designed online lesson can engage them and they will most likely learn from this activity.

Now a days, online activity does not have to be an exercise in solitude. With online communities like Second Life, chat rooms etc. there is potential to develop very rich synchronous and asynchronous online learning.

Take a look at this small example of an online "solo" learning module.
and compare it to a the typical click through modules with a quiz. There is no way to compare these..

Well designed online learning can work for a number of topics but a blended approach may be the best.
Allow students to explore online content and then come to class to discuss questions etc...

Neil said...

a timely article can be found here

Sharon said...

I agree with the majority of posts that there needs to be a combination of learning modalities to meet the various learning styles of the participants so I am not sure an exclusive online curriculum is ready for prime-time yet! The strongest negative feature of online is the lack of audience feedback to the teacher. We pace our lectures and determine the need to rephrase/restate concepts by paying attention to our audience's nonverbals. Unless you use streaming video - that entire dimension is eliminated. So until videostreaming becomes standard - we will need to continue to use both f2f and online to maximize/optimize learning across generations and learning styles.

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