Using online technologies to support new ways of learning for medical students
After a number of years of study and planning by faculty, staff, and students, Queen’s University’s School of Medicine in Kingston has introduced a new curriculum that is competency-based, with 13 key areas of competency including basic science and clinical components of practice, communication with patients and family members, collaboration and teamwork with other professionals, and scholarship and lifelong learning. To achieve these competencies, a new focus has been placed on active learning in which students work in small groups, guided by their professor, to solve authentic case-based problems.
Within the School of Medicine, new approaches to teaching and learning have been developed to support active learning facilitated by a team of faculty and educational specialists as well as by a locally-developed open source learning management system.
To meet the needs of the Queen’s medical curriculum, Entrada, an integrated teaching and learning management system (LMS) was developed within the Med Tech Unit. Entrada is an open source system that can be used, copied, and modified by users anywhere. The application within the Queen’s School of Medicine is called MEdTech Central. The Schools of Nursing and Rehabilitation Therapy use customized versions – SoNIT and RehabCentral. Entrada is now being co-developed with the University of Calgary and other institutions.
Faculty can use MEdTech to post syllabi, learning objectives, lecture notes, slides, podcasts, videos, readings, quizzes, assignments, and any other information linked to courses. Discussion groups can be set up by faculty, staff, and students to be as inclusive or exclusive as fits their goals and used for collaboration and exchange of documents and images. The social networking capacity of MEdTech is particularly important for its applications in interdisciplinary and case-based learning.
There have been pilot projects linking students from the Schools of Medicine, Nursing, and Rehabilitation Therapy using Entrada, facilitating online Interprofessional collaborative learning. The Learning Together with Cases web site, created by linking a series of MedTech “communities”, features a series of fictional, media rich, virtual patient cases, with a framework of questions, text, photos, x-rays and other images, and videos of ‘patients’ addressing the camera. The students can be brought together in a classroom or the virtual world to view the cases and discuss possible diagnoses and care. The social networking tools allow the students from different disciplines to share perspectives, despite different schedules and class times.
The cases illustrate the importance and benefits of sharing analysis and care with other health professionals. For example, medical, nursing, and occupational therapy students review a video of a patient and her daughter expressing their concerns related to her recent wrist fracture. Working face-to-face or online, they identify and respond to the patient issues, in the process discovering how their roles intersect and complement those of their other professional colleagues. In addition to preparing a treatment plan for the patient, students are asked to reflect on what they learned about roles during the exercise.
To further the interprofessional aspects of working, the web site also features a number of modules on interprofessional practice and tools for teachers developed by the Queen’s Office of Interprofessional Education and Practice. To facilitate sharing of these resources, many have been created under Creative Commons license and so may be accessed by educators at www.learningwithcases.com.
Professor Lindsay Davidson, who has been involved in the development of numerous online modules and other e-resources used within the School of Medicine as well as the Learning Together with Cases project, coordinates and teaches the first year medical student Musculoskeletal Course, using a blended learning format. In what she describes as “inverting the paradigm”, the students learn from the interactive modules before coming to class so that they are better able to take part in case-based discussions. The modules use static images and video to illustrate concepts. As well, there are often online “starter” cases, with questions for reflection, as well as multiple choice quizzes as a way of engaging students before they come to class.
Outcomes and Benefits
One of the unexpected benefits of working to create the online cases to be used for interprofessional education was the interprofessional faculty development.
The use of Entrada has been well-received by students as it not only gives them access to a wide range of learning materials, including the class objectives, notes, audio-enhanced slides and formative quizzes but also provides up-to-date schedule information, a dashboard for administrative notices and the easy-to-use “communities” feature which supports both curricular and extra-curricular online collaboration and learning.
The student response to the modules offered by Dr. Davidson illustrates the benefits of using the blended model to support active learning. Almost 99% of the students in the first year of the program agreed with the statement that “The course online modules helped me to learn and better understand the course material.” The online modules, completed prior to class, support enhanced classroom activities, emphasizing problem solving, active learning, and more complex case problems than the previous lecture-only method.
The modules and resources have been made as granular as possible, allowing sharing of both fully formed e-learning resources as well as the sub-components such as images, video or assessment tools.
Among the competencies essential for graduates in the School of Medicine is “lifelong learning and scholarship”. The use of online resources and self-administered formative assessment provides both a model of learning practice and access to essential resources for the students.
Challenges and Enhancements
One of the biggest challenges has been encouraging professors to reduce the amount of information they include in online modules. Many professors in the School of Medicine teach only one or two classes in their specialty and so want to share as much information and as many readings as possible. Helping them understand the structure and limitations of modules and their role in the learning process requires ongoing faculty development and support. Increased attention also needs to be paid to issues of instructional design and focus in the modules.
Consideration is being given to using online cases to link students when they are in the field. Medical collaboration and interprofessional cooperation are recognized as essential to effective medical practice, and online networks can facilitate and encourage this.
Dr. Davidson is working to get more of the online materials onto peer-reviewed external medical sites such as MedEdPORTAL from the Association of American Medical Colleges. This has involved useful learning about what works better for external sites, such as fewer links, and sharing this with her colleagues. She encourages using Creative Commons (open access for use and revision) licenses for as many resources as possible so that they can be more easily shared.
The development of the open source learning management system Entrada and the availability of resources on the web for other institutions to use in teaching and learning indicate the openness of Lindsay Davidson and her colleagues to joint development and sharing with colleagues.
For Further Information
Surgeon and Associate Professor
Department of Surgery
School of Medicine
Faculty of Health Sciences