Web Based Learning in Rheumatology, where are we now, and where do we need to be?
We all know about the potential of the web, but how should it be best put to use? Here are some of my musings frommy own thoughts on web based learning and rheumatology as it stands today.
When considering web based learning (WBL), extensive research has been conducted to compare e-learning against more traditional teaching methods. Up until recent years, the majority of educational research studies into WBL were non inferiority studies, or comparisons of additional e-learning resources ‘added into’ standard curricula (Cook, 2005, 2008). The largest meta-analysis of WBL learning in healthcare conducted to date has concluded that it is not if, but how we deliver web based learning that is the most critical question facing educators (Cook, 2008). It was confirmed by Wong (2003) that delivery of web based teaching is not simply a case of ‘putting your course on the web’. Robust evidence does not exist on exactly how the delivery of this material influences learning. Few studies attempt to directly compare two different approaches, with almost no data on an ‘interactive video’ based approach compared to a standard online presentation of material.
WBL in Rheumatology
Education in musculoskeletal medicine provides some evidence for some forms of WBL when added to traditional methods (Wilson, 2006); however I have identified no trials that compare different online strategies to teach a clinical skill. Various e-learning techniques have been tried, but they are often not web based. The Arthritis Research Campaign (ARC) have produced a more traditional CD ROM based e-learning package has been evaluated, and been shown to improve OSCE scores post intervention and improve self reported confidence (Vivekananda-Schmidt, 2005), however WBL has not been studied extensively studied by the ARC, or other research groups.
How is WBL Delivered
Web based learning (WBL) is commonly delivered in the form of a Virtual Learning Environment (VLE). A VLE can be thought of as a navigational menu driven system by which a student directs his or her educational pathway through a series of resources or activities. Any accessory materials such as pre/ post teaching evaluation can be delivered, with the results often being automatically collated by the VLE. This structure allows the delivery of educational material to trainees, in a reproducible, secure way. Each VLE can be accessed by students and teachers, with different priorities and user privileges available to users depending on a pre determined level of access.
Online material can be presented I a number of formats inside a VLE, namely via traditional text and pictures with associated connections between topics (hyperlinks), or via more detailed methods incorporating video and audio based aids to assist in their development. There is evidence to support that the more sophisticated the technology or advanced the delivery method, there is an increased associated cost. Furthermore this has been shown as one factor to dissuade medical schools in the United States to sharing online e-learning material, or producing open access medical resources (Huang, 2007).
In summary there is a large amount that is still to be studied relating to web based learning in Rheumatology. Where do we go from here?
Selected References and Further Reading, if you're interested...
Badcock LJ, Raj N, Gadsby K, Deighton CM. Meeting the needs of increasing numbers of medical students--a best practise approach. Rheumatology 2006;45(7):799-803.
Cook DA, Levinson AJ, Garside MD et al. Internet-Based Learning in the Health Professions, A Meta-analysis. JAMA. 2008;300(10):1181-1196.
Cook DA. The research we still are not doing: an agenda for the study of computer-based learning. Acad Med 2005;80:541-8.
Cook DA. Where are we with Web-based learning in medical education? Med Teach. 2006;28(7):594-8.
Downing SM. Reliability: on the reproducibility of assessment data. Med Educ. 2004;38(9):1006-12.
Huang G, Reynolds R, Candler C. Virtual Patient Simulation at U.S. and Canadian Medical Schools. Acad Med. 2007;82:446-451
Kay LJ, Deighton CM, Walker DJ, Hay EM. Undergraduate rheumatology teaching in the UK: a survey of current practice and changes since 1990. Arthritis Research Campaign Undergraduate Working Party of the ARC Education Sub-committee. Rheumatology. 2000;39(7):800-3
Norman G Eva KW. Quantitative Research methods in medical education. AMSE. Edinburgh 2008.
Vivekananda-Schmidt P, Lewis M, Hassell AB.Cluster randomized controlled trial of the impact of a computer-assisted learning package on the learning of musculoskeletal examination skills by undergraduate medical students. Arthritis Rheum. 2005 15;53(5):764-71.
Wilson AS, Goodall JE, Ambrosini G, Carruthers DM, Chan H, Ong SG, Gordon C, Young SP. Development of an interactive learning tool for teaching rheumatology- a simulated clinical case studies program. Rheumatology (Oxford). 2006 Sep;45(9):1158-61.
Wong G, Greenhalgh T, Russell J, Boynton P, Toon P. Putting your course on the Web: lessons from a case study and systematic literature review. Med Educ. 2003;37(11):1020-3.